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CORNELL 

UNIVERSITY 

LIBRARY 




Cornell University Library 
RM S71.M74 1902 



The treatment of disease by electric cur 




3 1924 012 176 958 



■RM 
^7 1 

(So 2 



t^l 




Cornell University 
Library 



The original of this book is in 
the Cornell University Library. 

There are no known copyright restrictions in 
the United States on the use of the text. 



http://www.archive.org/details/cu31924012176958 



THE TREATMENT OF DISEASE 
BY ELECTRIC CURRENTS 



THE GLEN SPRINGS, 

Wat';' -■ r •:- r.'. Y. 

MEDICAL L >RARY, 

PLEASE. U = . PLACB 
WHEN THf UUG . EADINQ. 



THE _,,.,i r,--T;'^" 



TREATMENT Of DISEASE 
BY ELECTRIC CURRENTS 



A HAND-BOOK OF 

PLAIN INSTRUCTIONS FOR THE 
GENERAL PRACTITIONER 



■■-■.; ■;"■ -"r: -:.• '\A -J. ". -i .> --• ■- ■ 
S. H. ^QNELls, . M:.:D. 

Founder and Chief Instructor of the Brooklyn PoM-Graduate School of Clinical £lectro- 
Therapeut'rcs and ^jR^ntg^n Ph~Sogi:kphy ;' Fellow of the Ntw ,-^,or,k Academy of 
Medicine; Mj!rfjl>er,:«f t%?$JeW Yotk Qoiipty Medicsl'- Soie'ie\yi''^d New 
York Efetrica So(!lety ; Editor of the Electro-Therapeutic De- 
partment of the Medical Times iind^Rtgister; . AMtbor-:\ -; ^ 
•■■ , of " MCfal pf Stwic iElectricityjin X-Ra j , 3 '*"'■. '^^^ "^'V' 
C .' v'J"^"' —' Ind "Ilieftipeutic Uses 

'>-^>-- -■ ■ ' •''f • :■■ "Yi ^' i-J ■;-'"•-' iv'' ■ 



THIRD EDITION 



3RK i^^ ■! Un ;:.;• 



^ 



NEW YOR,K ■it; + -| , , 



E. R. PELTON, ^Publisher 

19 EAST SIXTEENTH STREET 
190a 









Entered according to Act of Congress, in the year 1897, by 

F. W. OAKEY, 

In the Office of Librarian of Congress, at Washington 



All Rights Reserved 



PREFACE. 



Galvanic, faradic, and static currents are important medi- 
cal remedies which can only be prescribed by those who know 
how to use them. The treatment of disease by electric cur- 
rents is an essential part of the practice of medicine. It has 
been my aim to make this treatise a plain hand-book of in- 
struction in the medical uses of electricity. It is therefore free 
from electro-technics and terms which the general practitioner 
may not understand. Even in nosology I have avoided for- 
mal classifications of disease and have chosen descriptive terms 
of clinical significance rather than the system of the lecture 
room. 

I have attempted to clear away many of the perpkxities of 
the subject. The central facts of electro-physics and physi- 
ology are condensed into a few chapters, while the major 
portion of this treatise deals with therapeutics alone. I have 
aimed to make every chapter as instructive as a clinic. As 
the name of a disease does not always signify the pathological 
state or stage of a progressive lesion, I have described the 
electrical treatment for a variety of different clinical conditions 
in important diseases so that the physician can turn to these 
pages for practical help in the treatment of his own cases. 
The reader will find explicit indications for the selection of 
current, choice of poles, application of electrodes, regulation 
of dose, and duration and frequency of treatment, throughout 
the therapeutic range of galvanic, faradic, and static currents. 

The X-ray methods of employing the static apparatus are 

described in the author's Manual of Static Electricity in X-Ray 

and Therapeutic Uses, and are therefore omitted from this 

volume. 

S. H. MONELL, 

New York. 



CONTENTS. 



Preface pagt « 

CHAPTER I. 

The Status of Modern Electro-therapeutics, . . . pages 2X' 27 

CHAPTER II. 

Electric Currents as Medical Remedies, .... pages 2H — 33 

CHAPTER III. 

Practical Points in General Electro-physics. 

Definition of chief terms. Resistance and its management. Magnetism, Pri- 
mary and secondary currents. Definition of " tolerance." Electrodes. 
Special electrodes for galvanic work. Faradic electrodes. Static electrodes. 
To reduce resistance of galvanic electrodes. " Active " and " indifferent " 
electrodes. How to test the polarity of each current. Therapeutic polarity. 
The choice of galvanic poles in treatment. Indications for positive. Indi- 
cations for negative. The choice of faradic poles. Choice of static poles. 
Practical operative methods. Preference for simplicity in technique. Length 
of seances, pages 34 — 66 

CHAPTER IV. 

The Essentials of Galvanic Electro-physics. 

Cells, elements, and switchboards. Portable galvanic batteries. Exciting fluids 
How to connect a meter in circuit. Milliammeters. Rheostats. Accessory 
appliances, pages 67 — 81 

CHAPTER V. 

Physiological and Therapeutic Actions of Galvanic Currents Upon and 
Within Living Tissues pages 82 — go 

CHAPTER VL 
Cautery Apparatus pages 91—94 

CHAPTER VIL 

The Essentials of Faradic Electro-physics, 

The transforming device. Difference between galvanic and faradic currents. 

7 



8 CONTENTS. 

How to test " high tension " induction coil apparatus. Quality tests for fara- 
dic interrupters. The author's apparatus. Recording the dose of faradic 
currents, ■ ' ■ • ■ • pages 95— 124 

CHAPTER VHI. 

Physiological and Therapeutic Actions of Induction Coil Currents 
WITH Rapid and Slow Interruptions, 

/' 
Effects of different rates of interruption. Effects of rapidly interrupted high 
tension currents. Effects within the pelvis. Effects of different coils, 

pages 125—134 

CHAPTER IX. 

Therapeutic Effects of " High Frequenxy " Currents, . pages 135—136 

CHAPTER X. 

The Essentials of Static Electro-physics. 

Care of the apparatus. Dose regulation. Standard current tests, 

pages 137—157 
CHAPTER XI. 

Static Electro-physiology. 

The actions of static electricity in various forms of application. The importance 
of familiarity with this branch of the subject. Action upon functions. The 
chief -properties of static electricity determined by scientific investigation 
before the discovery of galvanism. Cavallo's accurate i-eport. Sedative ef- 
fects described by Arthuis in 1871. Static electricity as a regulator of func- 
tions. Its nerve and muscle reactions. Its effects upon metabolism and 
nutrition. Mechanical effects of the spark. Vasomotor effects. Revulsive 
effects. Sedative i;(;)-«(s stimulating effects. Relief of pains. Its great service 
in nervous and functional conditions and all diseases associated with malnu- 
trition. Its action upon the deeper tissues of the bod}'. Its great penetrating 
capacity. Leyden-jar currents. Their physiological actions similar to cur- 
rents from improved induction coils. Rapid and slow interruptions, and 
nerve and muscle effects. How to determine the difference between large 
and small jar currents by actual use. A comparison of Leyden-jar currents 
with induction coil currents in practical use. Length of seances. Principles 
governing same pages 158—174 

CHAPTER XII. 

Static Methods— Production of Special Effects. 

Arrangement of patient on the static platform. Management of accessories. 
Positive electrification. Negative electrification. The author's method of 
potential alternation. Positive static breeze. Negative static breeze. Posi- 
tive or negative static spray. Massage roller applications. The static cage. 
Positive static sparks, frictional and percussive. Leyden-jar currents. Gen- 



CONTENTS. 9 

eral sedative effects. Local sedation with ttie static breeze. General stimu- 
lation effects. Local stimulation with the static breeze and spark. Static 
polarity effects. Counter-irritant applications. Nutritional applications. 
Muscle contracting methods. Massage, electiical and hand. 

pages 175—205 
CHAPTER XIII. 

Indications and Contra-indications. 

Indications for electric cun-ents. Principles governing therapeutic indications- 
The polar theory of disease. Indications for static electricity. Contra-indi- 
cations of galvanic, faradic and static currents. Aggravations by static elec- 
tricity. Precautions after treatment. Relation of common condition to 
success or failure in general electro-therapeutics. Disrobing for general 
electrical applications, pages 206 — 222 

CHAPTER XIV. 

Electro-diagnosis for the General Practitioner. 

Scope of electro-diagnosis in practice. Motor points. How to locate liiotor 
points without a chart Galvanic and faradic reactions in pelvic diseases. 
Their diagnostic value, , pages 223 — 237 

CHAPTER XV. 
Treatment of Pelvic Diseases. 

Chief clinical methods. Percutaneous galvanism. Vaginal bipolar faradization. 
The technique of bipolar sedation. Duration and frequency of treatment. 
Vaginal bipolar stimulation. Clinical hints. Intra-uterine bipolar applica- 
tions. Massage and electricity in gynecology. Faradic apparatus for pelvic 
practice. Galvanic precautions. How to regulate galvanic dosage with 
large currents. Aids to the diagnosis of pelvic lesions. Indications for elec- 
tricity in gynecology. Intra-uterine " cauterization," . . paees 238 — 275 

CHAPTER XVL 

Treatment op Menstrual Derangements. 

Simple amenorrhoea. External and internal methods of treatment with both 
galvanic and faradic currents. Amenorrhoea due to chronic degenerative 
changes. Clinical remarks. Amenorrhoea from deficient uterine develop- 
ment Amenorrhoea following surgical operations. Diminished menstrua- 
tion in plethoric women. Scanty and irregular menstruation. Menstrual 
apathy following shock, etc. Simple delayed menstruation. Remarks, 

pages 276—292 
CHAPTER XVIL 

Treatment of Menstrual Derangements (Coniinued). 

Menorrhagia. Passive hemorrhagic states of the uterus. Metallic-electrolysis in 
hemorrhage. Remarks on bleeding states of the uterus. A beginner's expe- 



lO CONTENTS. 

riehce with post-partum hemorrhage. Foetid menstruation and foetid leucor- 
rhoeal discharges. Static electricity and menstruation in general. Cervical 
and lumbar backache of women. Gynecological wrecks. The menopause. 
Premature menopause. Puberty pages 293— 306 

CHAPTER XVIII. 

Treatment of Dysmenorrhea. 

Dysmenorrhcea due to endometritis. Dysmenorrhoea in young girls. So-called 
neuralgic, congestive, and ovarian types. Dysmenorrhoea complicated with 
uterine disease. Membranous dysmenorrhcea with profuse or scanty flow. 
Dysmenorrhcea with stenosis of the canal. Dysmenorrhcea with incomplete 
development of the uterus. Percutaneous galvanism in simple forms of 
dysmenorrhcea. Dysmenorrhoea due to inflamed ovaries and inflammation of 
the tubes. A discussion on dysmenorrhoea. Various methods of treatment, 

pages 307--324 

CHAPTER XIX. 

TREATMENT OF UTERINE ENLARGEMENTS. 

Venous engorgement of the uterus and pelvic tissues. Congestion, catarrhal in- 
flammation, and enlargement of the uterus caused by mechanical displace- 
ment. Subinvolution. Electrical methods. Chronic subinvolution. Treat- 
ment of complications. A case of chronic metritis, . . pages 325—335 

CHAPTER XX. 

Treatment of Uterine Displacements. 

Recent cases. Displacements with relaxed and congested conditions of the uterus 
and vaginal walls. Treatment of chronic anteversions and anteflexions. 
Treatment of chronic retroversions and retroflexions. Treatment of uterine 
c-onditions due to relaxation of muscular fibre and altered nutrition. Uterine 
prolapsus. A case of procidentia. A surgical discussion upon the treatment 
of retro-displacements of the uterus, pages 336 — 358 

CHAPTER XXI. 

Treatment of Endometritis and Uterine Inflammation& 

Recent and simple endometrijs. Endometritis in yovmg girls. The treatment 
of chronic endometritis. Endometritis associated with slight metritis. En- 
dometritis complicated by a salpingitis or other peri-uterine inflammation. 
Hemorrhagic and fungous endometritis. A clinical hint. Catarrhal inflam- 
mation with profuse leucorrhoea. Chronic endometritis of the cervix with 
erosion, induration and unhealthy granulations. Chronic endometritis of 
the cervix with erosion, oedema and soft, swollen state of the tissues. 
Chronic uterine hyperplasia with uterus large and soft ; with induration ; 
with extension of inflammation to the tubes and ovaries. Gonorrhceal 
metritis pages 359—382 



CONTENTS. 1 1 

CHAPTER XXII. 

Treatment of some of the Lesions of the Cervix. 

Neglected minor lacerations of the cervix. Erosion of the cervix. Ulcerations 
and non-malignant degenerations of the cervix. Stenosis of the internal Os. 
Clinical case. To soften the indurated angle of a sharp uterine flexion, 

pages 3*S3— 392 
CHAPTER XXIII. 

Treatment of Ovarian Lesions and other Pelvic Derangements. 

Congested and prolapsed ovary. Ovaritis. Reflex pain in the breasts. Pelvic 
pains. Obscure uterine derangements. Ovarian neuralgias. Pelvic pain 
dependent upon disordered innervation. Ovarian irritation and menstrual 
irregularity in young women without evidence of local disease. Post-opera- 
tive pelvic pain. Post-operative electrical treatment, . . pages 393—406 

CHAPTER XXIV. 

Treatment of Pelvic Inflammation. 

Pelvic peritonitis in acute stage. Clinical cases. Chronic peri-metritis and in- 
flammatory exudations. Clinical remarks. Acute catarrhal endo-salpingitis ; 
subacute ; chronic. The treatment of catarrhal salpingitis. The treatment 
of suppurative salpingitis. Abscess of fallopian tube. Remarks upon sup- 
purative peri-uterine inflammations. Pelvic haematoma and haemotocele. 

pages 407—432 
CHAPTER XXV. 

Treatment of Miscellaneous Pelvic Conditions. 

Vaginismus. Treatment of simple and gonorrhoeal vaginitis. Vaginal leucor- 
rhcea. Prolapse of the vagina. Vulvitis. Pruritus vulva. Eczema of the 
vulva. Treatment of dyspareunia. Sterility. Treatment of uterine causes. 
Neuroses having their origin in uterine conditions. Urethritis in the female. 
Stricture of the female urethra. Functional disturbances of the urethra and 
bladder, pages 433— 453 

CHAPTER XXVI. 

Treatment of Extra-uterine Pregnancy. 

Method of galvanic application. Method of faradic application. A clinical ex- 
ample treated by each current, pages 453—461 

CHAPTER XXVII. 

Obstetrical Uses of Electric Currents. 

Pregnancy as a contra-indication for various electric currents. Uterine inertia 
in parturition. A clinical case illustrating three methods of faradic applica- 
tion. Indications for the faradic current during labor. Baird's method. 



12 CONTENTS. 

Post-partum hemorrhage due to atonic state. Involution. Discussion on 
electricity in obstetric practice. Super-involution with amenorrhoea. The 
induction of premature labor. Post-puerperal'metritis. Post-puerperal dis- 
charges. Phlegmasia alba dolens pages 462—483 

CHAPTER XXVIII. 

Treatment of Vomiting of Pregnancy, or Reflex Irritation. 

pages 484 — 496 
CHAPTER XXIX. 

Uterine Fibroids and Treatment of Patients. 

Medical methods. Clinical varieties of fibroid tumors. Surgical methods and 
indications for each. Indications for galvanic electricity and other currents. 
Relative place of electrical methods as adjunct to medicine and surgery. The 
tediousness of any form of treatment. Clinical results in different varieties 
of cases pages 497—518 

CHAPTER XXX. 

Electrical Treatment of Different Varieties of Fibroids. 

Treatment of fibroids without serious symptoms or complications. Treatment of 
fibroids with various degrees of hemorrhage. Treatment of fibroid patient 
with suspected complication which may contra-indicate electricity. Treat- 
ment of intra-mural fibroid, single or multiple, situated in close proximity to 
the raucous membrane. Intra-uterine pedunculated fibroids. Sub-mucous 
fibroids of considerable size. Small uncomplicated fibroids of all varieties 
except pedunculated polypi. Interstitial fibroid of moderate size with desper- 
ate and profuse hemorrhage. Fibroid complicated with pyosalpinx ovarian 
cyst, or ovarian abscess. Cystic fibroids. Suppurating fibroids. Large 
fibroids complicated with pregnancy. Sub-peritoneal fibroids, 

pages 519—535 
CHAPTER XXXI. 

Electrical Treatment of Fibroids {Continued). 

Inoperable fibroid complicated with severe purulent metritis and endometritis. 
Inoperable fibroid with inaccessible uterine canal. Typical varieties for 
electrical treatment. Interstitial non-bleeding fibroid. Interstitial bleeding 
variety. Electrical melhods for the control of hemorrhage. Clinical re- 
marks as to choice of method. External method of treating fibroids. Vaginal 
and abdominal puncture pageg S36I560 

CHAPTER XXXII. 

Treatment of Genito-urinary Conditions. 

Sexual debility in the male. Spermatorrhoea. Treatment of complications 
Treatment of irritable stage. Treatment of post-irritable and paralytic stage! 
Functional sexual debility in the male. Symptomatic impotence. Irritable 



CONTENTS. 13 

atonic impotence. Treatment of different stages. Psychical impotence. Par- 
alytic atonic impotence. Atrophy of the testicles. Sexual hypochondriasis, 

pages 561—583 
CHAPTER XXXIII. 
Treatment of Genito-urinary Conditions (Continued). 

Enuresis. Treatment of incontinence of urine in adults. Urethritis and gonor- 
rhoea." Gleet. Epididymitis, acute and subacute. Pains of varicocele. Oi"- 
chitis. Tubercular orchitis. Treatment of hydrocele. Acute cystitis. 
Chronic cystitis, . ^ pages 584—602 

CHAPTER XXXIV. 

Treatment of Urethral Stricture. 

Directions for treatment by electrolysis. Urethral spasm and hyperzesthesia. 
Discussion of urethral stricture and electrical treatment. Linear electrolysis, 

pages 603 — 620 
CHAPTER XXXV. 

Treatment or Prostatic Disease. 

Atrophy of the prostate. Acute congestion of the prostate. Chronic prostatitis 
Treatment of enlarged prostates. Discussion upon different methods, 

pages 621—633 

CHAPTER XXXVI. . 

Treatment of Rectal Conditions. 

Hemorrhoids., Rectal stricture. Rectal ulcer. Peripheral irritations. Prolap- 
sus ani, pages 634 — 644 

CHAPTER XXXVII. 

Special Therapeutic Methods. 

The electric light as a therapeutic agent. Therapeutic properties of X-rays. 
Sinusoidal currents. Cataphoresis. Metallic electrolysis. Zinc-amalgam 
electrolysis. Thermo-electric currents. Electric water-bath. The electric 
douche. The electro-therapeutic cabinet bath. Central galvanization and 
general faradization, pages 645—680 

CHAPTER XXXVIII. 

Treatment of Digestive Disorders. 

Dyspepsia and functional derangements of, the alimentary canal. Nervous dys- 
pepsia, galvanic and faradic methods. Intestinal dyspepsia. Gastralgia. 
Chronic gastritis. Cholera morbus. Cholera infantum. Colic. Nausea, 
Intra-gastric electrization. Treatment of constipation. Chronic cases. Gal- 
vanic and faradic methods. Static sparks. Simple atonic constipation. In- 
testinal obstruction. Hydro-electric douche method. Intestinal obstruction 



14 CONTENTS. 

following abdominal surgery. Intestinal inertia with flatulent distension. 
Alternate constipation and diarrhoea. Torpid liver. Enlarged liver or spleen, 

pages 681—706 

CHAPTER XXXIX. 

Treatment q,t Pain. 

Varieties of pain relieved by static electricity, by the breeze and its modifications; 
by sparks, and Leyden-jar currents. Relief of pain by galvanic currents. 
Relief of pain by faradic currents. The relief of anomalous pains by elec- 
trical sedation . . pages 707—719 

CHAPTER XL. 

Treatment of Headaches. 

The local treatment of pain in the head. Constitutional treatment by static elec- 
tricity. Galvanic and faradic methods. Hemicrania. Migrane. Anaemia 
and congestion of the brain, pages 720 — 727 

CHAPTER XLI. 

Treatment of Neurasthenia. — By Static Electricity. 

Simple and symptomatic. Acute or chronic. Static electricity the sheet-anchor 
of treatment. Operative methods. The treatment of local symptoms in 
neurasthenic cases. Constitutional benefits of general electrification in neu- 
rasthenia. Differential indications. Frequency of treatment. Auxiliary 
medication. Prognosis. Facility of static methods. Principles governing 
current action in neurasthenia. Clinical remarks. Crying spells. " Nerves," 

pages 728—738 

CHAPTER XLII. 

Brain-fag and Insomnia. 

Brain-fag, acute or chronic. Refreshing elTects of static electricity. Technique 
of methods of treatment. Value of static electrification to professional brain 
workers. Chronic cerebral exhaustion. Acute neurasthenic insomnia. 
Chronic insomnias. Importance of improving nutrition. Successful treat- 
ment by electric currents. Four chief methods. The technique of static 
treatment. Prognosis,' pages 739—747 

CHAPTER XLIII. 

Treatment of Neuralgias and Neuritis. 

Resources of electricity. Facial neuralgia. Supra-orbital neuralgia. Neuralgia 
from lead hair tonic. Neuralgias in general. Methods of static treatment 
in dilTerent parts of the body. Prseeordial pains. Neuralgia of the heart. 
Treatment of sciatica. Faradic method. Galvanic method. Static methods 
in full. Clinical observations upon sciatica. Traumatic neuritis and recent 



CONTENTS. 15 

or chronic effects of cold and damp. Neuritis, recent stage. Faradic seda- 
tion ; ctironic stage. Weather neuroses and their treatment, 

pages 748—772 

CHAPTER XLIV. 
Treatment of 'Muscular Rheumatism. 

Treatment of lumbago and all forms of muscular rheumatism and muscle pains. 
Obstinate chronic lumbago and similar conditions. Static methods. Faradic 
treatment of muscular rheumatism of the arm and lower extremities. Faradic 
treatment of lumbago. Clinical remarks comparing galvanic, faradic currents 
in myalgias. Treatment of wry neck following abscess. Stiffness and sore- 
ness of the neck muscles following inflammation of the throat, 

pages 773—783 

CHAPTER XLV. 

Treatment of Articular Rheumatism. 

General faradic treatment. Local galvanic treatment. General and local static 
treatment. Obstinate and unyielding articular rheumatism. Swollen and 
painful joints without acute inflammation. Rheumatic stiffness and partial 
paralysis. Sore and tender bony prominences. Rheumatic headaches. 
Rheumatic derangements of circulation and temperature. Obstinate linger- 
ing pains. Duration of treatment. Dynamos and rheumatism. Gonorrhoea! 
rheumatism. Treatment of rheumatoid arthritis by combined galvanic and 
static currents. Clinical case illustrating special galvanic methods. Chronic 
synovitis. Treatment of arthritis by lithium cataphoresis, . pages 784 — 808 

CHAPTER XLVI. 

Treatment of Paralysis. 

Clinical precautions in treatment. Forms of paralysis. Electro-diagnosis. Prin- 
ciples of treatment. Treatment of muscular atrophy. Paralysis of sensation. 
Treatment by static and faradic currents. Facial paralysis from cold. Treat- 
ment of post-diphtheritic paralysis. Paralysis and atrophy of the deltoid, 
trapezius, etc. ; galvanic, faradic and static methods. Obstetrical paralysis 
of infants. Lead paralysis from lead poisoning. Infantile paralysis follow- 
ing poliomyelitis. Facial spasm. Paralysis agitans, . . pages 809—835 

CHAPTER XLVH. 

Treatment of Writer's Cramp. 

Typewriter's and telegrapher's paralysis. Acute or chronic fatigue of special 
muscles. Treatment of the early stage of writer's cramp with complete cure. 
Treatment of middle stages with symptomatic relief and either marked im- 
provement or entire cure. Treatment of paralytic stage of writer's cramp. 
Results obtainable. Treatment of cramp and spasm, . . pages 836—844 



l6 CONTENTS. 

CHAPTER XLVIII. 

Chronic Functional Nervous Diseases. 

Principles of treatment with static electricity. Temporary functional nervous 
derangements. Methods of treatment. Acute chorea of children. Clinical 
methods of treatment. Results. Treatment of limited chorea. Treatment 
of chronic chorea in adults. Indications defined. A consideration of different 
methods, pages 845-853 

CHAPTER XLIX. 
Morbid Mental States. 
The physiological action of static electricity. Effects of electricity in regulating 
the functions of the mind and body. Clinical cases, with the results of treat- 
ment. Auxiliary galvanic methods, ... . pages 854 — 869 

CHAPTER L. 

Treatment of Hysteria. 

Electricity in hysteria. Spinal irritation and hysterical spine. Hysterical paraly- 
sis. General treatment pages 870—875 

CHAPTER LI. 

Treatment of Chronic Cachexias. 

Chronic malarial cachexia. Syphilitic cachexia. Malaise. Chronic cachexias in 
general. Epilepsy. Acute or chronic grief, .... pages 876—883 

CHAPTER LII. 

Chronic Gout and the Uric Acid Diathesis. 

Chronic gout. Methods of treatment. The uric acid diathesis. Value of static 
electricity in treatment. Effects of diet. Status of drug treatment, 

pages 884—891 
CHAPTER LIII. 

Fibrous and Exophthalmic Goitre, pages 892—897 

CHAPTER LIV. 

Treatment of Pulmonary Affections. 

Effects of electrical treatment in relieving symptoms and promoting nutrition. 
Method of treating the local and general conditions of patients. Important 
actions of various applications. Clinical cases. Chest pains of pneumonia. 
Treatment of asthma. Faradic applications in diseases of the chest. 

pages 898 — 912 
CHAPTER LV. 

Treatmnet of Cardiac Affections. 
Functional heart derangements. The treatment of chronic heart diseases, 

pages 913- ■121 



CONTENTS. 17 

CHAPTER LVI, 
Bright's Diseases and Diabetes. 

Treatment of patients with chronic nephritis. Floating kidney- Relief of symp- 
toms. Treatment of diabetes mellitus. Treatment of diabetes insipidus. 

pages 922 — 927 
CHAPTER LVn. 

STRANGUtATEU AND IRREDUCIBLE HERNIA, " . . pages 928—934 

CHAPTER LVni. 

Electric Currents in Orthopedics and Fractures. 

Orthopedic diseases improvable by electricity. Faradic currents in fractures. 
Fibrous ankylosis of joints. Lateral curvature of the spine, . pages 935 — 940 

CHAPTER LIX. 

Treatment of Locomotor Ataxia. 

Uses of static electricity. Uses of galvanic currents. Treatment for different 
stages of the disease. Cases illustrating special galvanic methods, 

pages 941—950 
CHAPTER LX. 

Electrical Treatment of the Eye. 

Paralysis of external muscles. Twitching of the eyelid. Acute ophthalmia from 
injury, foreign body in the eye, etc. Treatment of conjunctivitis, granular 
lids and trachoma. Dilatation of the lachrymal duct. To remove irritating 
eyelashes. Keratitis. Asthenopia from debility, anaemia, the tobacco habit, 
advancing age or excessive use of the eyes. Congestion and anaemia of the 
optic nerve or retina. Optic neuritis. Optic atrophy. Retinitis diabetica. 
Retinitis pigmentosa. Corneal opacities. Ocula.- hemorrhage. Static elec- 
tricity in eye affections pages 951 — 967 

CHAPTER LXI. 

Electrical Treatment of the Ear. 

Chronic inflammation of the middle ear and sequelae. Meniere's disease. Tin- 
nitus aurium. Treatment by galvanic current. Treatment by vibratory mas- 
sage. Acute nervous deafness. Treatment of catarrhal deafness by vibratory 
massage. Static electricity in diseases of the ear, . . . pages 968 — 975 

CHAPTER LXn. 
Electrical Treatment of the Nose. 

The electro-cautery in nasal diseases. Fundamental principles of cautery appli- 
cation. Atrophic rhinitis. Chronic rhinitis, ozoena, etc. Metallic electroly- 
sis. Interstitial electrolysis. Clinical remarks. Hypertrophy of the nasal 
septum. Anosmia pages 976—989 



1 8 CONTENTS. 

CHAPTER LXIII. 

Electrical Treatment of the Throat. 

Electricity in diseases of the pharynx. Anaesthesia. Hyperaesthesia. Paraes- 
thesia. Rheumatism and paralysis of the pharyngeal muscles. Chronic fol- 
licular pharyngitis. Chronic hypertrophy of pharyngeal tonsils. Diseases 
of the larynx from altered nutrition. Aphonia. Hoarseness of singers and 
speakers. Author's method of treatment, • pages ggo—iooo 

CHAPTER LXIV. 

Galvanic and Faradic Currents in Skin Diseases. 

Neuroses of the skin. Acne rosacea. Treatment of a red nose. Cosmetic effects 
upon pale and hollow cheeks. Circumscribed dermatalgia or hyperaesthesia 
of the skin. Tinea. Felon. Secondary syphilitic and other eruptions in 
which germicidal inliltration is indicated. Barber's itch. Fissure of any 
mucous membrane. Benign vascular tumors. Benign tumors of the 
breast. Small vascular na;vus. Corns and callosities. The removal of warts. 
Keloid. Dermatitis, acute sunburn, etc Chilblains. Treatment of chronic 
ulcers. Ganglion. Bubo . pages looi— 1018 

CHAPTER LXV. 

Static Currents in Diseases of the Skin 

The place of static electricity in their treatment. Its value for the relief of symp- 
toms and to promote nutrition. The importance of improving the general 
health in the treatment of skin diseases. The relief of itching, burning and 
painful symptoms by static electricity. The class of cases to which it is 
suited. Falling of the hair from debility or defective nutrition of the scalp. 
Method of treatment. Effects. Alopecia. Indications for static electricity 
found in the constitutional state of the patient. Local and general benefits of 
electrification. Acne. Static electricity useful to promote systemic nutrition. 
Its influence upon the causes of acne. An efficient auxiliary aid to treatment. 
Local ana;sthesia.s. Anhidrosis. Carbuncle. A clinical case. Dermatalgia. 
Static electricity relieves the symptom and treats the cause. Dermatitis. 
Beneficial action of the sedative breeze in acute inflammations of the skin. 
Eczema. Symptoms and causes indicate static electricity. Principles of suc- 
cessful treatment of eczema with static electricity. Elephantiasis. Probable 
relief of symptoms by static sparks. Epithelioma. Temporary relief of pain 
by the static breeze. Erysipelas, pages 1019 — I02g 

CHAPTER LXVL 
Static Currents in Diseases of the Skin {Continued). 

Boils and persistent furunculosis. Curative elifects of static treatment. Herpes 
and herpes zoster. Value of static sedation in acute stage. Relief of burn- 
ing, itching and neuralgia. Value of static electricity in chronic and debili- 
tated cases. Hyperaesthesia. A clinical case treated with static electricity. 



CONTENTS. 19 

Hyperidrosis of the feet. Leucoderma. Negative results of treatment. 
Lupus. Indications for the general nutritional effects of static electricity 
after surgical measures. Pruritus. Static electricity the most successful 
remedy. Report of cases. Method of treatment. Psoriasis. Static elec- 
tricity to improve the nutrition of the patient. Scrofuloderma. Indications 
for static electricity as an adjunct to medical treatment. Dandruff best 
treated by the static head-breeze. Varicose ulcers. Improvements of local 
nutrition by static sparks. Tenderness of the scalp. Chronic urticaria. Re- 
lief ofJtching and constitutional improvement. Remarks upon the general 
usefulness and limitations of static electricity in the treatment of cutaneous 
affections pages 1030 — 1030 

CHAPTER LXVII. ' 

Acute Glandular Inflammation. 

Faradic sedation in inflammation of the parotid gland. Faradic sedation in cases 
of carbuncle s pages 1040 — 1045 

CHAPTER LXVIII. 

Miscellaneous Conditions. 

An electric bath for children. Faradism in infantile marasmus. Static electricity 
in infancy and childhood. The congestive chill stage of intermittent fever. 
Catalepsy. Cold extremities. Habitual subnor;nal temperature. To abort 
an incipient cold. Acute fluent coryza. Sprains and contusions. Hypostatic 
congestion and local oedema. Ascites. Exudations and infiltrations. Chronic 
varicose conditions of the lovyer extremities. Phlebitis. Obesity. Hiccough. 
Morphine habit. Chronic alcoholism. To eliminate metallic poisons by an 
electrolytic bath. To produce local anaesthesia by cataphoresis. Relief of 
toothache. Painless dentistry. Sore and bruised gums following dental work- 
pages 1046 — 1065 

CHAPTER LXIX. 

I Tonic Effects in Various Conditions. 

The crises of acute asthenic diseases. Faradic sedation in acute disease. Acute 
physical exhaustion. The debility of old age and chronic invalidism. Con- 
valescence from acute exhausting diseases or any low state of health. Value 
of static electricity as a tonic agent. Chronic effects of shock. Chronic 
effects of heat prostration. Nervous chill pages 1066— 1080 

CHAPTER LXX. 

Appendicitis, Meningitis and Tetanus. 
Special clinical cases pages 1081— 1088 



THE TREATMENT OF DISEASES BY 
ELECTRIC CURRENTS. 



CHAPTER I. 
THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 

This is an age of both medical and electric progress. The 
desire is universal to know something of an agent which has 
revolutionized the lighting industry, the transmission of motor 
power, and street railway traction, and which is destined to 
enter still more largely than it now does into the commercial, 
domestic, and medical work of the future. In most electrical 
lines the days of experiment are over, and the facts are now 
so well established that the generation of electricity is as 
closely standardized as are steam engines or bolts or screws. 
There is no need of attempting to explain what electricity 
really is, for the laws which govern its use are as well defined 
and as thoroughly understood as those which apply to light, 
heat, or air. 

No intelligent person is now expected to remain ignorant of 
the fundamental laws of electricity, and its chief practical ap- 
plications in the arts and sciences. A chair of electrical engi- 
neering is established in all our universities, colleges, and 
schools of higher education, and it is now only a question of 
time when every medical course will provide instruction in 
electro-therapeutics. 

There have long been two prevalent errors in regard to 
medical electricity. Some assume that it is yet in its " in- 
fancy," while others, with equal ignorance of the facts, say 
that " electricity is a science which is changing so continually 



22 THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 

and making such rapid advances " that the knowledge of to- 
day will be obsolete to-morrow, ergo— it is premature for phy- 
sicians to learn anything about it. These views would fit the 
therapeutics of massage, of cod-liver oil, Dover's powder, 
Fowler's solution, tincture of iron, iodide of potassium, Magen- 
die's solution, mistura rhei et sodii, calomel and quinina sul- 
phate, vini ipecac, nux vomica, and aconite as well as they fit 
.the therapeutics of the various electric currents. 

The three great currents now employed in medicine date 
from about the years 1832, 1800, and 1750. They have been 
weighed in the clinical balance, tested in laboratories, and 
proved by experience. Ninety per cent, of the practical uses 
of these currents have been established so conclusively, that if 
the general profession should suddenly advance up tO the 
world's sifted knowledge of electro-physiology and thera- 
peutics, the benefit to patients would represent the greatest 
progress in clinical medicine this generation has ever seen. 
Scores of able and scientific men have carefully developed the 
great study of electricity in its relation to disease. 

New chemical drugs multiply so rapidly that it is impossi- 
ble to remember the names from month to month, but the 
very greatest remedies remain with us unchanged in value, 
and do not undergo any " rapid advance," either in their cura- 
tive properties, dosage, or methods of. administration. 

Among these time-tried and priceless remedies electricity 
has won a foremost place. As it is popularly regarded as still 
in its infancy, and still undergoing rapid advances in methods 
of application, let us consider what " advances " are actually 
taking place. 

The basis of scientific development in the application of 
electricity to both industrial and medical uses is Ohm's law. 
This was published in 1827, and for seventy years has been 
the bulwark of investigators, who rely upon it in all mathe- 
matical calculations. It does not change with time and is a 
fixed law, which, like the law of gravity, can undergo no 
" rapid advance " or be impaired by " new discoveries." 



THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 23 

The uses of medical electricity to-day involve certain meth- 
ods and apparatus. " Rapid advances," if any are taking 
place, must effect these in a revolutionary manner. Familiar- 
ity with the history of the subject summarizes the prominent 
facts as follows : 

Static Electricity was introduced to medicine about the 
year 1750. Almost every disease now successfully treated by 
this agent was successfully treated by it a century ago by the 
pioneer investigators who originated the apparatus and most 
of the clinical methods. The methods and electrodes then 
employed are still practically the same, with the exception of 
Leyden jar currents, which date from 1881 — sixteen years ago. 

Static apparatus reached nearly its improved form in 1885, 
and the latest machine has now been in the market since 1893. 
The last therapeutic method to be introduced was described 
by the present author in 1893. 

The physiological actions of static currents were demon- 
strated and reported by scientific observers in 1 775-1 790, and 
again in 1840-50. Modern researches between the years 1885 
and 1895 confirmed the accuracy of the previously published 
facts on this subject and added little to them. 

Static electro-therapeutics in expert hands have been sub- 
stantially matured. " Rapid advances " or further " discover- 
ies " can hardly impair or alter the ascertained value of the 
various forms of current derived from the Holtz machine. 
The great improvement which has been going on during the 
past three years, and which has received a wonderful impetus 
through Roentgen's discovery of X-rays, consists chiefly in the 
spread of knowledge among individuals who were before un- 
familiar with this branch of medicine. This is an important 
advance, but it does not alter the existing facts ; it simply dis- 
seminates them among a greater number of people. The 
sound development of the decade just closed has placed static 
electro-therapeutics upon a firm and reliable basis. 

Galvanic Electricity. — This current may be considered 
to practically date from the year 1800. External applications 



24 THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 

of galvanic medical currents are either local or general. Gen- 
eral applications are confined to a single method (central gal- 
vanization), which was described many years ago and which 
retains the form of its long since established technique. 

Localized external applications of the galvanic current have 
received ninety-seven years of gradual clinical development, 
and are as well determined at the present day as the dosage 
and clinical methods of employing ipecac. It is impossible to 
point out any important novelty or new method of application 
which has been introduced to galvanic technique within the 
past two years, and we are now in possession of reliable meth- 
ods which procure the most useful therapeutic effects of this 
current. If all physicians understood the best inethods 
now known, there would be no further mention of rapid 
advances. 

The chief of special galvanic methods are (i) Apostoli's 
methods ; (2) Metallic electrolysis ; (3) Hydro-electric meth- 
ods. 

The gynecological methods of Apostoli were matured by 
himself and others during the decade 1885-189S, and since 
then have remained practically unimprovable. Metallic elec- 
trolysis received large experimental attention prior to 1894, 
by which time its therapeutic uses were well established, and 
the possibilities of further rapid advances in this valuable 
method are about equal to the same prospect with regard to 
the cautery, or carbolic acid, or Dover's powder, or tincture of 
'iodine. 

Cataphoric medication was first demonstrated many years 
ago and received its final development between the years 1886 
and 1 89 1. As operators have repeatedly proved that all sol- 
uble remedies can be conveyed into the tissues from surface 
electrodes there is little room for further " advance " in the 
principle of cataphoresis, for the principle is the same whether 
the drug employed be new or old. 

In hydro-electric applications special electrodes and improved 
methods of employing older measures were introduced from 



THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 2$ 

1888 to 1894, and these are now substantially settled in their 
appropriate place in electro-therapeutic procedures. 

Galvano-puncture and galvano-cautery have been employed 
for so many years, and methods and instruments have been so 
conclusively established, that to expect further " rapid im- 
provement " of a revolutionary nature would be like expecting 
rapid advances in forceps, probes, and scalpels. 

It may reasonably be assumed, therefore, that galvanic 
electro-therapeutic methods are as well matured in the hands 
of educated experts as are the methods of ordinary surgery or 
the technique of vaccination. Galvanic apparatus, meters, 
rheostats, electrodes, etc., of superior construction and quality 
may certainly be purchased to-day with secure confidence that 
no development in sight will make them obsolete. The mar- 
ket is full of inferior goods, it is true, and those who make 
genuinely scientific electro-medical apparatus are few in number, 
but physicians should prefer to deal only with makers of 
approved experience and reliability. 

Faradic ElectrO-THERAPEUTICS. — The induction coil 
was the discovery of Faraday — a master-mind and a master 
electrician — in 1831-32, and it has been evolved to approximate 
perfection by the genius of electricians who have since builded 
on Faraday's work. Medical coils of high-efficiency are pro- 
curable to-day and have their period of experimental advance- 
ment several years behind them. 

External applications of Faradic currents may be local or 
general. General faradization was perfected, in technique, a 
score of years ago, and it has since witnessed no rapid advance 
for the sufficient reason that the established technique is com- 
plete. 

Localizing methods of employing induction-coil currents 
have been sifted by the experience of hundreds of operators 
for sixty-five years and have slowly matured with the gradual 
development of scientific apparatus. The limitations of cur- 
rent action do not allow of " continuous changes " in methods. 
The best methods remain as fixed as the methods of massage. 



26 THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 

The greatest innovations in modern " faradism " were the 
evolution of the high tension medical induction coil apparatus 
evolved from 1888 to 1895, and Apostoli's bi-polar method 
which was suggested by Tripier in i860 and perfected more 
than four years ago. So-called "rapid advances" in this field 
relate chiefly to the progress of the individual physician from 
personal inexperience to practical skill in what has already 
been long established and known to others. 

The physiological and therapeutic properties of faradic 
electricity were clearly defined (except as to most rapid rates 
of interruption) almost as soon as discovered 65 years ago. It 
was at once accorded a place in medicine and a popularity 
which time has vindicated. In every country it was investi- 
gated by scientific men, but the labors of Duchenne over-top 
his contemporaries. 

" This accurate observer and careful experimenter, by his 
thorough electro-physiological and neuro-pathological re- 
searches, at once firmly established the induced current on a 
scientific basis, and we may well," says the historian, " speak of 
this great apostle of faradism as the founder of modern electro- 
therapeutics. He not alone discovered the physiological and 
therapeutic properties of induction currents but developed and 
perfected them so that but little has been added since his day. 
He placed faradism, by his classical work from 1847 to 1855, 
almost where it now stands — 'far ahead of the present general 
knowledge.' He discovered the motor points of muscles, he 
made the distinction between primary and secondary coils, he 
recognized the difference between coils of heavy and of fine 
wire, and he taught the principle of concentrating the action 
of the current upon the locality which he sought to influence. 
" He who simply follows the course of Duchenne's investiga- 
tions (finished a quarter of a century ago) will review the more 
important physical, physiological, and pathological features of 
faradic electricity." 

A survey of the medical uses of galvanic, faradic, and static 
electricity (extensive and valuable as they now are), demon- 
strates that future progress beyond the best present results of 
leading and original workers, must be in minor details only, 
and that the chM principles of action and application — electro- 



THE STATUS OF MODERN ELECTRO-THERAPEUTICS. 27 

physiology and electro-therapeutics — are as nearly settled and 
confirmed by clinical experience as anything in drug physio- 
logy and therapeutics. 

Progress there will be, but the practitioner who lives in the 
present generation need not wait for the coming of a new 
Faraday before commencing the A. B. C. of a branch of med- 
icine which has already grown beyond the powers of any one 
man to employ its entire resources. The treatment of disease 
by electric currents is a profound study which may profitably 
engage the attention of every physician who is interested in 
the welfare of his patients, whether he desires to make per- 
sonal use of the resources of electro-therapeutics, or to merely 
qualify himself to give a consultant's advice. 



CHAPTER II. 

ELECTRIC CURRENTS AS MEDICAL REMEDIES. 

I LEFT a medical college to engage in the practice of med- 
icine, completely ignorant of the real therapeutic properties 
of electric currents, and somewhat prejudiced against electricity 
by the teachings of my alma mater, whose faculty held it in 
light esteem. Both myself and fellow-students rneasured the 
merits of the agent by the apparatus commonly exhibited, and 
it was impossible to set a high value upon a remedy that took 
its origin from tawdry boxes costing three, five, or even ten 
dollars. 

We did not then know one current or one battery from an- 
other, but viewed them in the same light, and regarded elec- 
tricity as almost exclusively a quack affair, unworthy of an 
educated physician's attention. I therefore often advised 
patients against electricity during my first year in general 
practice, and supported my advice by quotations from author- 
itative teachers. 

At that time I had never seen any apparatus except family 
batteries, and had not become aware as yet that any informing 
treatise upon the subject was in print. The fact that electro- 
therapeutics was an important and scientifically developed 
branch of medical practice, was not even suspected by me 
during my period of undergraduate instruction, nor. for a full 
year thereafter. The various subdivisions of important medi- 
cal currents and the different principles of galvanic and faradic 
apparatus were not only undreamt of when I advised patients 
that " electricity would do them no good," but I did not then 
know that a therapeutic static machine existed. My astonish- 
ment when informed for the first time that such an affair was 

28 



ELECTRIC CURRENTS AS MEDICAL REMEDIES. 29 

a therapeutic appliance, actually employed in medicine, was 
like that of the Indian who first saw a locomotive. 

Physiological effects were equally a terra incognita, and 
electrodes were all wooden handles terminating in a small 
flat sponge. 

About a year afterward, accident gave me a glimpse into the 
clinical capabilities of electricity. I saw a case of sciatica for 
which drugs had been prescribed in vain, improve and get well 
under the use of a coil current, and a desire to know more of 
such a remedy gradually developed. 

The first step in rational comprehension of the subject was 
my awakening to the fact that electricity was a generic word 
like heat, medicine, food, exercise ; and was not dosable as a 
remedy until prescribed in definite character and terms. It 
was next plain that an intelligent prescription of this remedial 
agent must select definitely the particular current, polarity, 
dose, application of electrodes, method, duration and frequency 
of treatment, as specifically as in drug medication ; and in 
order to do this the different electrical currents must be 
studied as medicinal agents. 

Up to this point galvanic, faradic, primary, and secondary 
currents were only separated in my mind by the notion that 
one was stronger than the other, and their real differences 
were not comprehended until the utter worthlessness of the 
crude toy known as the " family battery ." was revealed to me 
by later experience. Upon pursuing an intelligent plan of 
study I discovered that modern medical electricity is in fact 
a compound remedy, possessing many-sided actions and thera- 
peutic properties derived from different modifying devices in 
scientifically constructed apparatus, which alter its character 
and quality in various degrees, so that it performs many dif- 
ferent kinds of work and partakes of the nature of different 
remedies. 

I ascertained further that by varying the form, character, 
quality, method, time, frequency, and management of the 
administration, and by employing proper instruments, this 



30 ELECTRIC CURRENTS AS MEDICAL REMEDIES. 

remedial agent could be caused to produce the effects upon 
the general nervous system and nutrition, of either a sedative 
or tonic or alterative or stimulating remedy ; or could, by 
special or local applications, be so modified and employed as 
to exert physiological actions which could be classified with 
the effects of principle drugs, such as the motor-excitants, 
the tonics, sedatives, alteratives, nerve foods, diuretics, anti- 
spasmodics, anti-pain remedies, counter-irritants, restorative 
agents, and all aids to functional processes ; besides the chem- 
ical, electrolytic, caustic, and cautery effects of the direct gal- 
vanic current applied with bare metal electrodes. 

Coincident with this surprising knowledge came the revela- 
tion that there are now three chief sources of electro-medical 
currents: (i) The chemical cell, which generates the direct gal- 
vanic current of low voltage, large amperage and marked 
chemical action ; (2) The induction coils which interrupt the 
constant flow of the direct current, raise the voltage, reduce 
the amperage and create greater mechanical force with dimin- 
ished chemical action ; (3) The imposing static apparatus from 
which we derive currents of still greater voltage and dimin- 
ished volume. 

A complete galvanic apparatus requires a large number of 
cells (50 or 60), together with controlling and measuring in- 
struments for regulating the dose ; a coil apparatus (with 4 or 
6 cells only) must contain an assortment of coils of various 
lengths and sizes of wire, aggregating nearly eight thousand 
feet in various combinations ; and a therapeutic Holtz machine 
should contain six or eight revolving glass plates of not less 
than twenty-six or thirty inches in diameter. 

From these three different sources the great medical cur- 
rents take their origin, and the physiological actions upon 
which the curative properties of electricity depend, cannot be 
demonstrated in their entirety without employing complete 
and high-efificiency apparatus. 

When these unalterable facts became clear to me, the cheap 
faradic box, sold by many dealers in druggists' sundries, was 



ELECTRIC CURRENTS AS MEDICAL REMEDIES. 3 1 

recognized as the most insidious enemy the cause of scientific 
electro-therapeutics has ever known. It was seen to be a 
blight upon progress wherever it deceives and prejudices the 
physician, because it has no merit to redeem the gross quack- 
ishness of its nature, and is as deficient in true therapeutic prop- 
erties as it is cheap in price. 

Those who appraise the clinical value of medical electricity 
by the standard of pocket coils are as wide of the mark as ht 
who would estimate the capacity of an ocean steamship by 
the toy boat which a boy sails on a pond. No other influence 
opposes so great a barrier to adequate professional apprecia- 
tion of one of our very greatest curative agents as the count- 
less thousands of trashy coil batteries sold for popular use, and 
which are but a mockery in the hands of the ignorant. 

It took me some time to find this truth out, for I bought 
such a battery at the beginning and was inclined to be proud 
of it. They are, however, unfit for medical purposes regardless 
of greater or less cost, yet many cling (I long did myself) to a 
crude and utterly worthless faradic box, as if it was the 
fountain-head of the healing art. Once rid, however, of this 
retarding idea and in possession of properly constructed and 
high-efficiency electrical apparatus, the true merits of this 
valuable agent rapidly become clear. They assert themselves 
in daily clinical experience, and no longer need an advocate, 
for they become apparent to all observers. Conservative 
writers, in fact, do not now make any claims as to the merits 
and physiological action of galvanic, faradic, and static 
currents. They simply record approved demonstrations, and the 
entire medical world may verify the same. 

Prior to 1880 periodical waves of interest in electro-thera- 
peutics passed over the medical profession. The rise of such 
waves was due in each case to the genius of special workers, 
who devised exceptional apparatus and improved upon pre- 
ceding methods. Interest in reports of such men induced 
many others to seek for similar results in their own practice, 
and the wave of popularity rose high because of the instinctive 



32 ELECTRIC CURRENTS AS MEDICAL REMEDIES. 

belief, in the majority of mankind, that this wonderful agent 
must of necessity be valuable in medicine. 

The decline of the wave of general interest was due to the 
fact that the exceptional apparatus and skill of leading 
workers were not duplicated in the hands of hundreds of other 
practitioners who attempted to produce therapeutic results 
with non-therapeutic instruments, and who signally failed. 

Some employed a crude faradic battery in the belief that 
they were obtaining from it both galvanic and faradic cur- 
rents, and I remember seeing an announcement of one phy- 
sician who also derived static currents from the same source. 

While a large number of cheap electrical devices were made 
and sold, there was little appreciation of quality and the 
cheapest was considered "good enough," while the best in 
general use was exceedingly poor. When improvements were 
devised there was neither duplicate supply nor demand for 
them. In i860 Tripier had made for himself a faradic appa- 
ratus with a series of coils superior to anything in use at the 
time, or for the next twenty-five years. He also devised bi- 
polar electrodes and laid the foundations for the future work 
of Apostoli, but in his own day his efforts passed almost 
unnoticed. 

This state of affairs is now a thing of the past. The 
conquering march of industrial electricity has changed the 
whole aspect of the science. Prior to the introduction of 
the electric light and the. electric motor, the laws and princi- 
ples which control the actions of electric currents were practi- 
cally all discovered and established, but mechanical applica- 
tions were experimental and few. 

When mechanical applications became commercial, and 
reached, as they did during the past ten years, an investment 
of nearly a billion dollars in this country alone, there was no 
further room for any backward step in the development of the 
uses of electricity. A true appreciation of quality in an electro- 
medical apparatus is taking the place of the old idea that any 
kind of a contrivance will do. 



ELECTRIC CURRENTS AS MEDICAL REMEDIES. 33 

The law of supply and demand is taking practical effect. 
Manufacturers are providing, or will provide to order, perfected 
instruments which leave little to be desired. The practitioner 
now recognizes that good work requires good tools, as well as 
various tools, and that he cannot substitute a coil for a cell 
current or a static machine, but must refer each character 
of therapeutic work to the instrument which will properly 
accomplish it. 

There will never again be a down grade to the interest in 
scientific electro-therapeutics, but on the contrary there will be 
a gradual extension, throughout a larger and larger portion of 
the medical profession, of the knowledge that has been confined 
to a few, until, at length, the subject is adequately taught in all 
medical colleges, and every graduate becomes, familiar with the 
common principles of this great branch of medicine. 
3 



CHAPTER III. 

PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

Definition of chief terms. Resistance and its management. Magnetism. Prt- 
raaiy and secondary currents. Definition of "tolerance." Electrodes. 
Special electrodes for galvanic work. Faradic electrodes. Static electrodes. 
To reduce resistance of galvanic electrodes. " Active " and " indifferent " 
electrodes. How to test the polarity of each current. Therapeutic polarity. 
The choice of galvanic poles in treatment. Indications for positive. Indi- 
cations for negative. The choice of faradic poles. Choice of static poles. 
Practical operative methods. Preference for simplicity in technique. Length 
. of seances. 

This chapter is designed to be instructive to the physician 
who cannot spare time for either a clinic course or for much 
reading, and who wants the essential facts in a nutshell. 

Before we can successfully treat diseased tissues with electric 
currents there are two necessary steps of preparation. The 
first is a knowledge of how to use electrical apparatus, and the 
second is an understanding of the action of each different 
current upon and within living tissues. 

These branches of study are separately designated electro- 
physics and electro-physiology, and it is said that no one can 
be a master in electro-therapeutics unless he is also a master 
in these. There is nothing difficult about this, for it simply 
means dexterity in the use of tools and a knowledge of the 
work each will do. No one can be a good carpenter unless he 
knows how to use his saw, hammer, plane, chisel, measuring 
instruments, and other tools of his trade, and equally of course, 
no one can be a practical electro-therapeutist unless he is 
prepared to manage his apparatus. Practice teaches this 
simple dexterity after the principles are understood, and in this 
chapter I shall set down some of the chief general points 
to understand. 

34 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 35 

A working alphabet of the subject of medical electricity is ' 
first obtained by defining the ordinary terms in most common 
use. The definitions which follow should be carefully familiar- 
ized. 

Ampere. — The practical unit of galvanic current strength or 
rate of flow. It represents too large a unit for medical dosage 
and is therefore divided by one thousand, to establish the 
therapeutic unit, the milliampere. 

Amperage. — The expression of current volume or rate of 
flow. Galvanic currents possess large amperage, while faradic 
and static currents have very small amperage, in proportion to 
their respective E. M. F. 

Anode. — A synonym for the positive pole or electrode. 

Cathode. — A synonym for the negative pole or elec- 
trode. 

Circuit. — The entire pathway around which a flow of cur- 
rent is established by continuous conductors. 

Electrolyte. — An organic substance or fluid which can 
be caused to undergo chemical decomposition by the passage 
of a sufficient galvanic current through it. The human body 
is a complex electrolyte. 

Electrolysis. — A separation of compounds into elements 
by the action of an electrical current of sufficient amperage. 

Electro-Motive-Force. — The voltage of an electric cur- 
rent. Pressure and potential are often used to signify nearly 
the same thing. 

Elements of a Cell. — The plates of zinc and carbon. 

Excitant Fluid. — The chemical fluid in which the ele- 
ments of the cell are immersed. When the elements are acted 
upon by the solution, an electric current is generated. 

Faradic Electricity. — A general term for induction coil 
currents. It is inexact, because it does not distinguish between 
currents from different coils with diiferent rates of interruption 
and different qualities. 

Faradization.— A term signifying the application of some 
form of faradic current. 



36 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

Galvanic Electricity.— A general term for direct cur- 
rents from primary chemical cells. 

Induction Coils.— The mechanical devices which trans- 
form the direct galvanic current into induced or faradic cur- 
rents. 

Labile Application.— A term signifying that one or both 
of the electrodes is kept moving over a part during the treat- 
ment of a patient. 

Milliammeter.— The calibrated galvanometer used to in- 
dicate the number of milliamperes employed in treatment. It 
operates with continuous galvanic currents only. It cannot 
measure the interrupted galvanic or induction coil or static 
currents. 

MiLLlAMPERE.- -The medical unit of galvanic current 
dosage. The one-thousandth part of one ampere. 

Ohm.— The unit of electrical resistance. It is equal to the 
resistance of one thousand feet of No. lo pure copper wire at a 
temperature of seventy-five degrees F. 

Ohm's Law. — " The amperage of a current is equal to its 
voltage divided by the resistance of the circuit." In medical 
usage the quotient is the net dose in milliamperes. 

Potential and Pressure. — Both signify nearly the same 
thing as the voltage of a current. 

Quantity and Volume. — Inexact synonyms for am- 
perage. 

Rheophores. — The pair of conducting cords by which elec- 
trodes are connected to the battery terminals. Generally 
called " cords." 

Rheotome. — The device upon the .switchboard which inter- 
rupts current flow. 

Rheostat. — A current controller operating by " resistance." 

Series. — Connecting alternately the zincs and carbons of a 
series of cells. All batteries except cautery are connected in 
series. 

Stabile Application.— The opposite of labile, and signi- 
fies that the electrode is kept still during treatment. 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 37 

Short Circuit. — A circuit which is entirely composed of 
metallic conductors. 

Switchboard. — The part of the electrical apparatus which 
contains the devices for regulating the current. 

Tension. — A term closely related to voltage. High ten- 
sion currents are induced currents with high (medical) voltage 
and very small amperage. 

Volt.— The unit of electro-motive-force. 

Voltage. — Refers to the E. M. F. of an electric current. 
Voltage is the pressure force behind the current flow. Gal- 
vanic currents average between one and one-half and two volts 
per cell. Primary induction coil currents have an E)- M. F. of 
about ten volts per cell. Secondary coil currents multiply 
this in proportion to the increasing length, number of terms, 
and fineness of wire. The entire range of voltage afforded by 
an improved coil apparatus probably runs from zero up to 
about one thousand volts, while static currents possess a very 
much higher potential, estimated from 100,000 to 1,000,000, 
depending on the size and speed of the plates, dryness of 
room, etc. 

There are three factors in medical electricity with which the 
physician must become as familiar as he is with the influence 
of dosage upon the administration of drugs. 

1. Electro-motive-force depends upon the difference of poten- 
tial at the two poles and furnishes to every electric current 
flow what the pressure of height does to a column of water with 
an out-flow at the base. 

2. Resistance is the ob.struction offered to the flow of current 
by the conducting materials which compose the circuit. 

3. Current is the electricity flowing through a conducting 
circuit. 

These three factors (Force, Resistance, and Current) must be 
considered in every application of electricity, for the current 
strength is obviously equal to the pressure divided by the 
resistance, and this is Ohm's law simply stated. It is the basis 
of exact measurement in electricity and was published by Dr. 



38 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS, 

G. S. Ohm, in 1827. It has stood the tests of time, and ranks 
with the laws of gravitation and of electric attraction and 
repulsion as a natural law to which there are no known excep- 
tions. 

It may often be presented at such length and with such a 
variety of algebraic formula as to bewilder the student of 
electro-therapeutics, but the simple understanding above given 
is a sufficient working basis. 

With the exception of the milliammeter measurement of the 
current strength of a single medical current (the constant 
galvanic) no measure of E. M. F. or R. or C. S. is made in 
ordinary electro-therapeutic practice. The resistance of a 
patient, or of different tissues of the body, is sometimes 
measured with appropriate instruments as a matter of curiosity 
or for purposes of investigation, but in clinical practice the 
physician simply switches into circuit enough E. M. F. to 
furnish the desired C. S. over the R. of the patient regardless 
of whether the resistance is twenty, or two hundred, or two 
thousand ohms. No instrument has yet been invented which 
provides a measurement of the voltage and amperage of in- 
duction coil and static machine currents and the proper reg- 
ulation of current strength is largely a matter of practical 
• experience. 

The meaning of the word Resistance is so clear that it needs 
no further definition, and in electrical writings its accepted 
meaning is unaltered. In electro-therapeutics we either wish 
to get rid of excessive resistance to the current flow or we 
employ it as a current controller or rheostat. We therefore 
manage resistance in one of two ways : 

I. To secure in treatment the greatest possible part of the 
electric current generated in the battery cells we convey it to 
the patient through the best possible conductors — copper wires 
and well moistened or metallic electrodes. Poor conductors 
deliver less current at terminals because they impede the 
current flow. It is better therapeutics and economics to prevent 
waste of current by applying it through good conductors than 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 39 

it is to purchase an excessive number of cells to offset the loss 
through bad conduction. 

2. To regulate the dose when the initial current is greater 
than we wish to pass through the tissues we interpose a con- 
centrated resistance (a rheostat or current controller) in a con- 
venient place on the switchboard and then control and regulate 
the administration by using just enough of the interposed 
resistance to impede the excess of current strength and conduct 
only the desired amount. 

The management of resistance in electro-therapeutics is 
practically accomplished by experience without exact measure- 
ments in ohms. 

Magnetism. — As the current from an induction coil is 
related to the magnetic saturation of an iron core in the 
primary coil we must obtain a general idea of magnetism and 
how it acts. 

Every magnet has two opposite poles. If it is cut in two 
each piece will be found also to have a north and south pole, 
one of which will attract the opposite pole of any other magnet. 
An electric current passing through certain metals sets up 
magnetic action, and conversely magnetism produces an electro- 
motive-force. 

When a number of turns of copper wire are spirally wound 
around a few soft iron rods they become magnetized during 
the flow of a continuous current through the surrounding wire 
and lose their magnetism when the current stops. The amount 
of magnetism they acquire from the current is Increased by 
increasing the amperage of the electricity. Two cells will 
therefore induce greater magnetic force than one, and four 
cells greater than two. Cells with large elements generate 
currents with larger amperage than cells with smaller elements, 
and consequently are more efficient in magnetizing the iron 
rods. 

Every increase in the magnetic saturation of these iron rods 
increases their effect upon the resulting induction current. 
The primdry and secondary currents of induction coils are 



40 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

created by the processes of induction which take place between 
the coils and the magnetized iron rods during the periodical 
activity of the primary cell current. 

We become so familiar with the actuality of induction that 
it is sufficient to be able to practically employ induced currents 
as we desire without attempting to follow the speculations of 
the philosopher into the nature of inductive influence. Faraday 
made the discovery of induction, and in some way or other it 
now enters into almost every practical application of modern 
electricity with the exception of primary cell currents. 

Primary and Secondary. — These words are familiarly as- 
sociated with faradic batteries, and many suppose that />rtmarj/ 
means the galvanic current and that only the secondary refers 
to the faradic current. As educated and experienced physi- 
cians have informed me that they shared in this common 
misunderstanding we must correct this error at the start. 

The -word primary on a battery switch and in printed direc- 
tions refers to the first coil of the induction device. The pri, 
mary current is the first induced current of a faradic battery, 
The word secondary refers to the current from secondary indue- 
tion coils which overlap the primary coil. 

These two words may refer elsewhere to either primary or 
secondary cells, or primary and secondary coils. The primary 
cell is the chemical cell and source of the direct galvanic cur- 
rent. The primary coil is the coil which is wound upon the 
core of iron rods and produces the primary induced current of 
a faradic apparatus. The secondary cell is- less familiar to 
physicians than the primary cell and is now generally called a 
storage battery. It does not generate a current itself, but 
requires to be charged from some primary supply. It is never 
employed in a faradic battery. Secondary coils are the lono-ei 
and major coils of the faradic apparatus, and the currents 
which we obtain from them result from the second induction 
process which takes place between them and the primary coil. 
Coils are really transformers of the proportions of voltao-e and 
amperage in electric currents which pass through 'them. 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 4I 

The primary coil current is an altogether different matter 
from the primary cell current, for the coil has acted upon the 
direct current of low voltage and large amperage and induced 
from it a current with three different characteristics. It is 
intermittent instead of continuous, has a high voltage and ex- 
ceedingly small amperage. These characteristics, and espe- 
cially their increased E. M. F., give to faradic currents their 
greater power to pass through resistances ; and because am- 
perage is now so attenuated in volume, and because chemical 
activity is still further diminished by interruptions, the faradic 
type of current from any form of induction coil, either primary 
or secondary, fine or coarse, long, medium, or short, performs 
no electrolytic or cautery work. It is wholly inadequate for 
such purposes. Its uses are rather electro-mechanical, for it is 
nearly all force. The primary coil in the best apparatus now 
made is chiefly a " step up transformer " between the primary 
cell current of low voltage and large amperage and a variety 
of secondary induction coil which provide us with secondary . 
induction currents with marked additions to their voltage and 
mechanical properties, and from which chemical action is al- 
most completely obliterated. 

As the E. M. F. ascends through the " step up " processes 
the ordinary resistances of the human body become insignifi- 
cant to the increased penetrating force of secondary coil cur- 
rents, and on this account we require only a few cells (i, 2, 4, 
or 6) to secure our therapeutic dosage. This explains why 
faradic batteries have so few cells instead of the large Yiumber 
usual in galvanic apparatus. The qualities of faradic currents 
of high therapeutic efficiency are not wholly dependent upon 
the size, character, or number of the cells employed, but are 
the product of refinements in the construction of the separate 
coils and interrupters which control the factors of E. M. F. 
amperage, and quality.- 

The advantages secured by altering the chemical current 
through inductive transformers will appear in our study of 
electro-physiology. They are valuable advantages, and sine? 



42 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

they have been secured with improved apparatus the range of 
farado-therapeutics has been extraordinarily increased, and 
earlier types of coil batteries must be discarded by all who 
attempt to follow the march of progress. 

The physician whose acquaintance with electricity is limited 
to a non-therapeutic " faradic battery," may ask why it is that 
different currents can affect the tissues differently. This is 
easily made clear by the same explanation which applies to 
water and air. 

Air and water act in one way when large volumes are nearly 
at rest, and in remarkably different ways when set in motion. 
These secondary effects are governed largely by the size and 
rate of the moving matter. The differences in the work per- 
formed by air supplying oxygen to the lungs, driving the sails 
of a ship, forcing a blast furnace, imparting its cold or heat to 
other bodies, furnishing pneumatic pressure in mechanics ; or 
of water floating a navy in a broad harbor, driving, in a narrow 
torrent, the wheels of a mill, descending in gentle showers 
upon a growing crop, putting out a fire, quenching thirst, and 
serving the domestic and medical purposes of mankind as 
either water, ice, or steam have their analogies in the different 
kinds of work which v/e can cause electric currents to perform, 
by setting them in motion in different quantities and different 
rates under different conditions, and with the aid of different 
mechanical helps. 

If we wish to develop predominantly the actions which 
most resemble those of mechanical forces we raise the voltage 
of a current upon the same principle that a rapid rate is given 
to a stream of water to produce horse-power for mechanical 
purposes. If we wish to develop the dynamic properties 
which are essentially inherent in electricity we use it in greater 
volume (amperage) and reduce the voltage so that mechanical 
action is subordinate. 

In order to avoid the trouble of continually shifting the 
relations between voltage and amperage in a single source of 
electric current, we find it much more convenient to employ 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 43 

separate apparatus which give us the altered types of current 
which experience has shown to be most useful. These ap- 
pliances furnish us still further means of regulating the 
dynamic and mechanical activities of each given current, so 
that having ascertained the entire scope of action of electricity 
at the present stage of the world's knowledge, we may definitely 
select the exact current to perform any part of the work 
which it is known that electricity will do. 

Before any physician can treat disease with electric currents 
he must know how to produce the effects of each current. 

Definition of Tolerance, — In order to obtain a regulation of 
dosage, in many cases in which no measuring instrument can 
guide us, we depend upon an educated acquaintance with what 
is briefly called tolerance of the tissues. The operator becomes 
as familiar with the sensory and motor effects of the various 
currents upon normal and pathological tissues, as the fingers of 
the gynecologist become trained in bimanual examinations, 
and as the ear becomes trained to the language of the stetho- 
scope. 

It is diiificult to put the full sense of the meaning of this 
term into words, but we qualify tolerance into diilerent degrees, 
such as mild, comfortable, and maximum. 

When an induction coil current is at the point of mild toler- 
ance it will produce very gentle muscular and sensory effects. 
When it is at the point of comfortable tolerance it will produce 
more vigorous effects, which combine energy with comfort 
and do not produce either pain or fatigue. When the maxi- 
mum tolerance is reached, we mean that the patient is on the 
verge of being taxed to endure the action of the current, no 
matter what its effects may be. The maximum tolerance 
may sustain a short application when some special effect is 
desired, but long applications of induction coil currents are 
rarely pushed to the point of causing pain and fatigue. 

When the galvanic current is applied for effects of a gen- 
eral nature rather than of limited electrolytic action, we are 
often controlled in the regulation of dose by the tolerance 



44 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

of the tissues instead of the reading of the meter. This is 
especially true in acute conditions associated with sensitive- 
ness and inflammation. In these cases a current is kept within' 
the hmit of comfortable tolerance when it produces perhaps a 
comfortable warmth or slight tingling, or pricking, but no 
sensation which annoys or aggravates. Usually this tolerance 
inereases steadily during the application, and a current which 
is maintained at the same number of mil. throughout a sitting 
may cease to be felt at all before the sitting is ended. 

When inaxiiniini tolerance is the guide to the limit of cur- 
rent strength it is the tolerance to the active electrode which 
is always meant. If this electrode is within the vagina or 
uterus, we pay no attention to the tolerance at the external 
electrode, except to increase the area of contact if the current 
becomes uncomfortable to the skin. The essential tolerance 
is that within the pelvic tissues, and any sign of pain or dis- 
comfort at the internal electrode during any form of galvanic 
treatment should always be heeded by the operator and the 
current reduced. 

The term has little or no reference tostatic applications. 

Electrodes. — Electrode is derived from two Greek words 
which signify an electric way. The definition given in the 
classical Century Dictionary is as follows : " A pole of the 
current from an electric battery or machine which is in use in 
effecting electrolysis ; applied generally to the two ends of an 
open electric circuit. The positive pole is termed the anode 
and the negative pole the cathode." 

This gives no hint of the real character and purposes of 
medical electrodes, and as faradic and static currents do not 
"effect electrolysis " the definition would leave them out of 
the account altogether. When we see the greatest Lexicon 
in the English language presenting a medieval crudity as an 
up-to-date definition of one of the most obvious words con- 
nected with the subject of electricity, and find in many new 
works upon neurology, materia medica, therapeutics, and the 
practice of medicine in general, not only lingering traces of 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 45 

the "Darkest Africa " era of electrical science, but almost a 
total disregard of its great modern development, we can regret, 
but we cannot wo?ider that the rank and file of the medical 
profession underestimate the value of electro-therapeutics. 

Without a variety of suitable electrodes the therapeutic 
effects of galvanic, faradic, and static currents are as impossible 
as would be surgical results without cutting, dissecting, and 
suturing instruments. With galvanic and faradic currents 
both electrodes must be placed in contact with opposite por- 
tions of the tissues through which the current passes. With 
platform methods of employing static currents the patient be- 
comes the terminus of one electrode, while the other is em- 
ployed as a means of locahzing and altering the rate of current 
discharge without actual contact with the patient. No influ- 
ence upon rate of change is exerted by galvanic and faradic 
electrodes. The dose regulation with these currents is accom- 
plished with complete independence of such manipulation as 
enters into the uses of static electrodes. 

All electrodes require a conducting surface and attachment 
to a conductor. With galvanic, faradic, and Leyden-jar cur- 
rents the conductors are attached to the terminals of the source 
of current. Static electrodes are grounded to the earth. 

Galvanic Electrodes. — The subject of material for galvanic 
electrodes has now passed beyond the earlier experimental 
stages of wash leather, flannel, punk, gelatine-graphite, animal 
membranes, spongio-piline, and other coverings suggested dur- 
ing the past thirty years. ' The variety of electrodes required to 
cover the wide range of galvanic therapeutics will necessarily 
include almost every form and character of electrode that is 
made, except the few which are distinctly associated with 
static and faradic currents. Galvanic electrodes are either 
"protected " or bare metal. If protected, the covering mate- 
rial must be absorbent and possess the quality of retaining 
moisture, for the material does not conduct the current, but 
protects the skin from burning effects and holds the conduct- 
ing solution in its meshes. 



46 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

Fine sponge, if kept clean, may best be used upon small and 
convenient hand electrodes for minor galvanic applications 
with small currents, and if the application is labile no other 
covering is equal to the fine, soft sponge selected for this pur- 
pose by the best makers and lubricated with soap. 

For extremely large dosage — a rare requirement in ordinary 
practice — the so-called Apostoli clay electrode, moistened with 
a hot water solution of bicarbonate of soda, renders the consid- 
eration of other materials unnecessary. A clay electrode in 
contact with the skin will conduct a larger amperage with less 
sense of irritation and pain to the patient than any other sub- 
stance yet employed ; but owing to the mussy nature of the 
material, it is used with reluctance and only when deemed 
necessary. The home-made clay electrode is unsatisfactory, 
but during the past year the Jerome Kidder Mfg. Co. have 
furnished hard-rubber molds lined with pure tin, which form 
shallow cups of assorted sizes, which may be filled with clay 
from a supply jar as occasion requires. Simply fill the mold, 
smooth off the surface, fit over it a piece of wet cheese-cloth 
to keep the clay in place and the electrode is ready for the 
patient. After treatment discard the cheese-cloth covering 
and the clay can be returned to the jar and used again and 
again. This set of cleanly electrodes does away with former 
objections. 

For the great range of external and stabile applications, be- 
tween the minor uses of sponge and the rare necessity for pot- 
ters' clay, there is practically but one material to consider for 
all sizes and shapes of protected galvanic electrodes. This 
material is the thick, firm, white felt used upon piano keys. 
It is not expensive ; is extremely durable, and when prepared 
for electrode use is thoroughly satisfactory. Manufacturers of 
electro-medical apparatus treat it to remove all grease and oil 
and either keep in stock or will make to order a complete va- 
riety of pad electrodes of assorted sizes covered with this felt. 
The occasional use of absorbent cotton as an impromptu 
covering for electrodes, to be freshly replaced at every treat- 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 47 

ment, will naturally occur to all electro-therapeutists. It is 
indeed recommended by some for general service on the score 
of cleanliness but the resources of soap, hot water, and a little 
ammonia will certainly never fail to supply this great desidera- 
tum. The texture of absorbent cotton does not permit its 
use in labile applications, hence it is inferior in this respect to 
fine sponge. It packs tightly under pressure and does not re- 
tain moisture so well as felt, and hence is inferior to the latter 
material also. 

These four materials, sponge, clay, felt, and cotton, are the 
most satisfactory in their separate places of any that are avail- 
able in general practice. They possess the merits of sim- 
plicity, convenience, and little cost. 

In addition to electrodes which consist of a metal base cov- 
ered with some material which will absorb and retain water, 
we find it often useful to employ water itself as the medium 
of conducting contact. A water-bath electrode can be impro- 
vised by placing warm water in any jar or bowl which will 
contain the part to be treated, and sinking to the bottom of 
the water the tip of a conducting cord connected with the 
proper pole of the galvanic or faradic battery. 

If a galvanic current is employed bicarbonate of soda, in 
proportion of a teaspoonful to a pint, should be added to the 
warm water. When the small joints of the hands or feet, the 
testicles or entire male genital organs, and parts of such ir- 
regularity of contour as to prevent contact with ordinary elec- 
trodes are to be subjected to the uniform action of any elec- 
trical current, the water-bath furnishes the only means of 
making contact at every point. It is a simple but indispen- 
sable device. 

This brings us to consider bare metal electrodes not covered 
with any material to restrict cutaneous irritation. Such elec- 
trodes are employed in a field of specialized applications ; 
rarely upon the external surface of the body, but chiefly upon 
mucous surfaces within the natural cavities, or inserted into 
tissues by needle puncture. Adaptability of size and shape 



48 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

to the parts subjected to treatment therefore regulate the se- 
lection of these electrodes as well as the composition of par- 
ticular metals. The negative pole of a continuous galvanic 
current does not attack metals, and it therefore makes no dif- 
ference what metal is used either in a uterine sound, a punct- 
ure-needle, or any other bare electrode provided it is con- 
nected with the negative pole. 

It must never for a moment be forgotten by the therapeu- 
tist, that the positive polar action of the galvanic current at- 
tacks and decomposes all metals of which electrodes are made, 
except platinum and gold. Gold electrodes are too expensive 
for common use and need hardly be considered. When the 
electrolytic action of the current alone is desired in any appli- 
cation with a bare metal electrode, the negative pole is used 
necessarily in all cases, except when platinum is employed 
with the positive. It must be remembered as an invariable 
rule that in all positive applications for purely galvanic elec- 
trolysis the electrode must be non-attackable by the current, 
or else one of two things will happen : the electrode itself will 
be injured by the corroding action of the current, or the tis- 
sues around it will be undesirably attacked by the metal de- 
composed from the electrode and driven into the tissues. To 
obviate these effects platinum is employed. 

The variety of platinum electrodes required by the average 
practitioner is limited to puncture needles and perhaps two 
intra-uterine sounds. With these there is little need for sub- 
stitute devices, but carbon electrodes and pure tin have occa- 
sional uses with medium and mild currents. Pure tin is not 
attacked by the positive current until the amperage reaches 
the intensity of strong currents, and as it is much cheaper 
than platinum we may employ it in a variety of sounds and 
tips. 

Distinctly separate from the consideration of the above 
electrodes employed for the administration of either positive 
or negative galvanic currents is a third class of bare metal 
electrodes which combine galvanic with metallic electrolysis in 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 49 

therapeutic action upon tissues. Tliese are employed only 
with the positive pole of the current and add to the effects of 
positive galvanic electrolysis the supplementary action of 
metallic salts formed from the junction of the decomposing 
electrode ions with the ions of the electrolyzed tissues and 
driven into the tissues by cataphoresis. The soluble electrodes 
employed for metallic electrolysis are usually either copper, 
zinc, or silver. They are made in assorted sizes of tips, gen- 
erally eight in a set, which screw upon a suitable insulated 
handle. Sets of sounds and needles are also made. Zinc 
electrodes may also be coated with mercury, and thus add 
zinc-amalgam to the varieties of electrodes. Iron, brass, and 
other metals have been experimentally tried, but we see that 
the minerals which possess the medical properties which prove 
valuable in their local actions when driven into the tissues by 
galvanic osmosis are for the most part those which are em- 
ployed in other forms of topical applications for similar local 
actions. The sulphate of copper, the chloride of zinc, nitrate 
of silver, and bichloride of mercury have familiar uses in both 
concentrated and dilute forms in topical medicine, and similar 
but much more effective and deeper acting results are 
achieved by the oxy-chlorides of the same metals when they 
are not merely applied to the surface of a mucous membrane 
without absorption, but are driven below the surface and 
saturate the tissues and undergo absorption into the circulation.- 

A number of different names were given to this valuable 
method of supplementing enormously the action of galvanic 
currents upon catarrhal inflammatory processes of mucous 
membranes during the period of its development, but I shall 
adhere to the single term metallic electrolysis to designate ad- 
ministrations of this character. 

Apart from the material of which any electrode is made it 
is obvious to the physician that it must, in some sensible sort of 
a way, conform itself to the size and shape of the parts to be 
treated and the dose of current strength which it serves to 
conduct. In ordinary external applications of galvanic cur- 
4 



50 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

rents with covered electrodes, the comfort of the patient will 
be best maintained if the area of the contact surface of the 
electrode reduces the current density below two milliamperes 
per square inch of contact. This relates to sedative or nutri- 
tional applications. It is density for a given area of contact 
and not the total of amperage that regulates the therapeutic 
effects and the comfort or discomfort of the application. An 
electrode 4x6 would reduce the density of 24 milliamperes to 
only one milliampere per square inch of contact, while 24 
milliamperes condensed into a contact of 2 x 2 would increase 
the density to 6 mil. per square inch. A practical way to dis- 
cover the difference in sensory effect is for the operator to 
demonstrate it upon his own cuticle. 

When large currents are employed by Apostoli's methods, 
they cannot be agreeably managed unless the external elec- 
trode is large enough to keep the density down to tolerance, 
but in all cases, the preparation of the electrode and skin to 
serve as good conductors is not less important than the size 
of the contact. 

When external applications are designed to affect a con- 
siderable area, an electrode large enough to cover the part is 
selected rather than any subdivision of the treatment by 
moving a smaller electrode from place to place. For instance 
the entire spine can be affected at once by employing a felt- 
covered electrode about three inches wide and about eighteen 
inches long. Abdominal electrodes may be 6x8, or 8 x 12 or 
such other sizes as may be needed. If we bear in mind the 
effects which a given density per square inch of current action 
enables us to produce, we have only to increase the number 
of mil. to an equal proportion for the entire area of contact to 
obtain similar effects with any size of electrode. 

In all external applications the operator must select a suit- 
able electrode from among his general variety, but in applica- 
tions which involve special methods the choice of a suitable 
electrode is much simpler than an unpractised reader might 
suppose, for many specialized methods have also specialized 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 5 1 

electrodes made expressly for them, and very little perplexity 
of choice can exist after the physician arrives at even a 
" bowing acquaintance " with the tools of electro-therapy. 

The therapeutic choice of faradic electrodes is exceedingly 
simple, for the variety is small and their different adaptabilities 
are obvious. 

Faradic Electrodes — The electrodes employed with fara- 
dic currents are of limited size and variety as compared with 
the extensive range , of galvanic electrodes. The reason is 
obvious, for faradic currents act chiefly along the lines of 
mechanical force. A single experiment demonstrates that 
vibrations, impulses, or blows, from either mechanical instru- 
ments or interrupted electric currents ' are not effectively 
delivered by too broad a surface ; hence large dispersing elec- 
trodes are never employed to cause muscular contractions, and 
the faradic electrode is usually small and compact. Metals 
are not actively affected by the current, and bare metal elec- 
trodes may be employed with either pole. Chemical differ- 
ences of polarity may be ignored by the practitioner in the 
use of induction coil electrodes. 

The choice of faradic electrodes is governed by convenience 
and the suitability of size and material to the manipulation of 
the operator more often than by other considerations. There 
is nothing in the action of faradic currents to prevent our 
using any electrode which we employ with the galvanic cur- 
rent, if it is convenient to do so. 

The essential electrodes are all included among the varieties 
essential to a galvanic outfit with very few exceptions. One 
of these exceptions is the so-called faradic brush or scourge. 
This electrode is mentioned in almost all references to the 
treatment of local anaesthesias, but all who have static appa- 
ratus have better means of treatment, which are far more 
agreeable to the patient. Bipolar electrodes are the chief im- 
portant varieties peculiar to the uses of faradic currents. The 
vaginal bipolar electrode is never employed with any other 
form of current, and may be regarded as the most typical 



52 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

illustration of the highest therapeutic attainments of the 
modern development of faradism. 

Static Electrodes.— The essential electrodes employed with 
platform methods are means of producing different degrees 
of local, convective or disruptive discharges. They are all 
pointed for convective discharges, and spherical for disrup- 
tive discharges. Pointed electrodes are brass, copper, or wood, 
and are single or multiple, fine or coarse. Ball electrodes 
are brass or wood, of larger or smaller sizes. The wooden 
electrodes have been furnished with machines for about one 
hundred and twenty-five years. They differ from metallic 
electrodes in being poorer conductors, and do not produce 
any effects which cannot be produced by the latter. They 
are, in fact, rarely employed. 

The massage roller electrode acts upon the same principle 
as the brass ball, and produces short disruptive discharges 
which are called frictional sparks, when it is employed in the 
usual way. It can be also made to produce other effects. 
Static electrodes all require grounding in order to fulfill their 
functions. 

The electrodes employed with Leyden-jar currents may be 
any that are employed with faradic currents, and need no sep- 
arate consideratiz'fv. 

To Reduce Resistance of Electrodes. — We have noted that 
the pressure force of each galvanic primary cell is only about 
one and one-half volts at origin. The wires throughout the 
apparatus are all linear conductors. They deliver the current 
to the patient in the same form that it comes from the cells 
with the volume (amperage) reduced by the resistance of the 
circuit. A battery of forty cells, with an E. M. F. of one 
and five-tenths volts each, represents only sixty volts of 
electro-motive-force, and through a resistance of two thou- 
sand ohms would give only about three mil. of galvanic 
current. This would be many times too small for some thera- 
peutic purposes and the satisfactory use of galvanic currents 
from an ordinary number of cells depends upon reducin"- the 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 53 

resistance of the circuit by saturating the electrodes with a 
solution of high conductivity. 

Plain water, either hot or cold, should never be used to 




■ rig I 

Set of Electrodes and Standard furnished with the Static Machine by the 

Manufacturers. 

If 1 :^ .^rinlirations. Its resistance is 

moisten electrodes for galvanic applicauoub. 

so great that with the metallic tips of two conducting cords 



54 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

placed about three inches apart in a shallow dish of water, the 
current between them is less than one mil. per cell. In clin- 
ically demonstrating the necessity of a good conductor it is 
usually found that the entire E. M. F. of twenty cells produces 
about twelve mil. in this experiment. Obviously the con- 
ducting properties of plain water must be improved, and the 
physician who knows how to do it rightly, has made a long 
start towards obtaining satisfactory dosage. It is a simple 
matter, although it is seldom explained in text books. 

To about one pint of hot water in which felt, sponge, or 
other protected electrodes are to be moistened, add about one 
teaspoonful of bicarbonate of soda. This does not oxidize 
electrodes and is clean, bland, cheap, and convenient. One 
grain of it added to the Water through which twenty cells 
produce only twelve mil. of current between terminals three 
inches apart, will instantly double the amperage. Two or 
three grains more will deliver to us four or five times the 
previous current from the same number of cells, and if we add 
half a dram of soda we can demonstrate five hundred mil. be- 
tween the electrodes which in plain water demonstrated only 
about twelve mil. 

When covered electrodes are applied to distant parts of the 
body, between which there may normally be too great resist- 
ance for the ordinary number of cells in a cabinet apparatus 
to produce the desired amperage, the value of knowing how to 
reduce the resistance by saturating the skin and the electrodes 
in a hot water solution of bicarbonate of soda is equal to the 
cost of any extra number of cells which would otherwise be 
required. The physician who has a cabinet of fifty cells need 
not buy one hundred and fifty, if he employs bicarbonate of 
soda in the above manner. 

Faradic electrodes do not require to aid the current in get- 
ting through the resistance of the skin. All currents of con- 
siderable voltage will readily penetrate any resistances of the 
body and all covered electrodes for use with induction coil 
Leyden jar currents may be moistened with plain water. 



or 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 55 

The " Active " and " Indifferent " Electrode.— In general 
electro-therapeutic writings the term " active electrode " is 
applied to the one at which the local polar action is chiefly 
sought. The " indifferent electrode " is the one required to com- 
plete the circuit without reference to any special local action. 

Either of these terms may therefore belong to either pol- 
arity at different times, but as they are more or less perplex- 
ing to the general practitioner I shall not employ them in this 
book, but will state exactly where both positive and negative 
electrodes are to be applied in every case. 

How to Test the Polarity of each Current. — To test gal- 
vanic poles : Place the metal tips of two conducting cords in a 
dish of plain water and connect them with the terminal posts 
of the galvanic switchboard. Start the current into action 
with any desired number of cells, five or ten. The metal tip 
which remains clear is positive. The tip at which bubbles of 
hydrogen gas appear is negative. 

To test induction coil poles : The Geissler tube test is in- 
fallible. Connect the terminals of. a small Geissler tube with 
the opposite poles of the induction coil apparatus. Switch the 
long coil, rapid vibrator, and four cells into circuit in a suffi- 
ciently darkened room. The lumen of the tube is at once 
filled with luminous radiations which appear like rolls of coin 
stood on edge. 

With a low voltage they are faintly seen, and are of a light 
blue or violet tint. As the voltage increases they become 
brighter, and with the entire Kidder coil and four or five cells 
in action the tube produces a bright light. The distinct discs 
are in active agitation and lean slightly in the direction of the 
current flow from positive to negative. The bulb of the tube 
at the positive end is clear, and a small spark is given off from 
the internal electrode. The bulb of the tube which is filled 
with a glow discharge like mist, demonstrates the negative 
pole. 

When the pole changer is reversed the discs lean in the 
opposite direction and the bulb which was clear becomes foggy. 



56 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

In the absence of a Geissler tube make slight contact with 
the tips of the thumbs upon two ordinary electrodes of any 
kind. Switch one or two cells, the rapid vibrator and anyone 
of the coils into circuit. Increase the current from zero until 
it is just felt. The electrode at which, sensation is greatest is 
connected with the negative pole. 

To test static polarity : Start the machine into action with 
the sliding poles near together so that a short spark stream 
passes between them, which is bright at one pole and violet- 
tinted at the other. The bright part of the stream identifies 
the positive pole. 

Draw the poles apart until the spark stream becomes a brush 
discharge intermingled with thin sparks. Draw the poles still 
further apart, and at the positive pole the stream will have a 
straight handle like a whisk broom. At the positive pole the 
spark stream will be visible after it has ceasied at the negative 
pole. Connect the brass point electrode by the usual chain to 
the gas fixture and interpose the point in the spark stream at 
either sliding pole. If the spark stream stops, and is conducted 
away by the electrode instead of passing between the. poles, it 
identifies the positive pole. If the spark stream continues to 
pass while the electrode is held against the ball to which the 
stream comes, this is the negative pole. 

The practised operator distinguishes static polarity at a 
glance, or by ear, by a dozen denoting signs both by direct 
test and during every clinical appHcation. It is always apparent 
to the expert which pole is connected with the platform, but to 
the beginner the above tests will demonstrate it conclusively. 

Therapeutic Polarity.— The Choice of Galvanic Poles in 
Treatment. — The puzzling question to the student of electro- 
therapeutics, more puzzling perhaps than any other that 
confronts him, is the choice of poles in treatment. This 
perplexity will be greatly reduced by repeated study of 
electro-physiology. The practical physician who familiarizes 
himself with the demonstrated effects of each pole, and 
applies the same therapeutic principles which guide him in 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 57 

the selection and dosage of different drugs, will have little 
trouble in deciding upon the polarity appropriate to any 
given case. The question of how much amperage is 
required to carry out any plan of galvanic treatment is also 
perplexing to many, but nearly all difificulties will be removed 
by close attention to a few important points. 

Owing to the opposite nature of positive and negative polar 
actions upon muscular fibres, circulation, and the electro-tonic 
state of nerves, it is impossible to ignore polarity in the clinical 
applications of external electrodes. These effects largely con- 
trol the question of the use of ascending or descending currents, 
for the direction of the current through human tissues is 
necessarily governed by the situation and relation of the 
electrodes. It is impossible to consider direction/^r .r^ as any- 
thing separate from polar action. In probably seventy-five 
per cent, of therapeutic work with the galvanic current it will 
be found that rational regard to polaritj', and indications for 
the situation of electrodes, will take the question of current 
direction out of debate. 

In external administrations the positive galvanic electrode is 
applied in the upper, and the negative in the lower, course of 
the nerve and arterial distribution when it is desired to have 
the current act with and reinforce the processes of circulation, 
metabolism, and the cerebro-spinal and sympathetic nervous 
system, to obtain the calming effects of analectrotonos, to rest 
the brain and promote sleep, to vitalize and refresh the mind 
and body in states of profound depression and asthenia, to 
lessen congestion, and to allay pains which are due to states 
which the vasomotor, osmotic, alterative, sedative-tonic action 
of the positive pole will relieve. 

The direct appHcation of the positive electrode upon a local 
part externally or within the soft tissues or natural cavities of 
the body is indicated by hyper-excitability of the nerve supply, 
by acute congestions and inflammations of soft tissues or 
glands, by the pains attendant thereon, by catarrhal inflam- 
mations of all mucous membranes in acute and subacute 



58 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

Stages, by irritation, redness and tenderness of a part, by soft, 
boggy, CEdematous or bleeding states of tissues, glands, or 
glandular organs ; but positive polar action in these applica- 
tions must be properly regulated in dose and duration of sit- 
ting so as to meet indications for a great variety of effects. 
The positive pole is indicated in profuse uterine non-sup- 
purative discharges, and in all electrolytic applications for 
denutritive, drying, coagulating, contracting, germicidal, hemo- 
static, caustic or acid cauterizing efTects in local vascular dila- 
tations, neoplasms and hemorrhagic states of the uterus. It is 
the pole employed in all the electrolytic uses of copper, zinc, 
silver, and mercury-coated electrodes. 

The positive polar action is germicidal when combined with 
metallic electrolysis in purulent and gonorrhcEal inflammations 
of mucous membranes and parasitic skin diseases with a much 
lower amperage than when acting alone. 

The chief uses of the positive galvanic current in inflam- 
matory, congestive and painful lesions, relate to the acuter 
stages and states of morbid irritability, with very mild dosage 
and short applications as the rule. 

When the galvanic current is interrupted to cause muscular 
contraction, polarity becomes a matter of less importance, but 
the positive electrode may usually be placed upon or nearest 
to the origin of the nerve supply, and the negative pole applied 
upon the part which it is desired to stimulate functionally. 
When more rapid rates of interruption are employed for mas- 
sage effects, the electrodes are usually placed so that they will 
act most effectively without regard to anji' chemical difference 
between the poles. 

The negative galvanic polar action is chiefly indicated in 
the chronic stages of disease, to increase metabolic activity 
and stimulate the processes of repair, or to destroy and elimi- 
nate the morbid products of acute inflammations. Its electro- 
lytic arid complex electrotonic action arouses latent glandular, 
circulatory, cell, nerve, and muscle irritability. It is the pole 
for localized anaemic, atrophied, apathetic conditions, and 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 59 

states of arrested functionation. By determining blood to a 
part and increasing local vascularity its action improves local 
nutrition. It is the pole to use to soften and absorb the 
chronic products of inflammation, exudates, indurations, en- 
larged glands, fibro-plastic deposits, .fibrous growths, and to 
soften and relax scar tissue and contractured muscles. 

Negative electrolysis destroys hairs, warts, moles, and other 
non-vascular growths. It promotes absorption of effusions, it 
softens and reduces a hard and enlarged uterus, dilates con- 
strictions of canals lined with mucous membrane, destroys ex- 
cessive granulation upon an eroded surface and promotes the 
healing of ulcerations. It stimulates the local blood supply 
of the pelvic organs and in scanty menstruation or amenor- 
rhoea and other starved states it restores the nutrient activity. 

Its softening and dissolving action overcomes stenosis and 
obstructions of the cervical canal and the indurated angle of a 
sharp uterine flexion, and it is the pole to employ in atonic 
and sclerotic conditions of chronic inflammation. Ankylosed 
joints, chronic arthritis, contractured tendons and muscles, 
and uterine fixation due to bands of adhesion, are usually 
to be attacked by negative polar electrolysis, followed in 
many instances by the mechanical action of an interrupted 
current. 

Many pains are relieved by the negative pole or by the pas- 
sage of a galvanic current through the parts without regard to 
polarity, and the presence of pain does not alone determine 
the choice of poles. The indications for the increase or de- 
crease of local irritability and blood supply in a part, the acute 
or chronic nature of the lesion and the well defined indications 
for positive or negative electrolysis are more reliable guides to 
the therapeutic selection of galvanic polarity than pain. 

The Choice of Faradic Poles. — No chemical differences of 
polarity affect the choice of faradic poles. In gross muscular 
applications with slow interruptions, place the electrode 
through which the current acts with the greatest vigor over the 
affected parts and the other electrode according to conven- 



6o PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

ience. In practice the most active polarity is the negative, 
unless a difference in the size of the electrodes is made to 
reverse the normal relation. 

When rapidly interrupted, high tension, induction coil cur- 
rents are directed with the blood current, they reinforce the 
"vermicular movement of arteries, the peristalsis of involuntary 
muscles, and the functional activity of nerves. Vibratory im- 
pulses in the opposite direction diminish both nerve and arte- 
rial currents, and the reasons for these opposite actions are the 
different degrees of muscular contractility set up by what used 
to be called the in-going and out-going current. Knowing 
these effects of polarity in all general faradizations with me- 
dium or rapid rates of interruption we at once know how to 
apply the electrodes. 

For sedative-tonic and nutritional effects in general applica- 
tions to the entire body, the negative electrode is placed at 
the feet, or at the base of the spine. 

For local sedation effects the positive electrode is placed 
over the site of congestion, inflammation, or pain, with the 
negative electrode situated so that the current will pass most 
directly through the affected parts. 

Local stimulating effects depend very largely upon the 
management of the administration and can be accomplished 
without exact reference to polarity, but the negative pole is 
usually employed. 

In all the remarkable range of effects produced within the 
pelvis by the bipolar method there is but one relation of polar- 
ity to remember. The positive terminal is always connected 
with the tip of the electrode. It is never used in any other 
way. 

In passing currents through what may be termed cross sec- 
tions of the body for conditions which do not actively indi- 
cate a definite location for any special polarity, but involve 
rather effects of general management and technique, we are 
governed chiefly by the size and character of the electrodes 
and operative convenience instead of polar action. 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 6l 

Choice of Static Poles.— With Leyden-jar currents the 
choice of polarity is governed by the same rules as induction 
coil currents. 

With platform methods there is no chemical difference 
between positive or negative electrification, but one may be 
made more active therapeutically than the other on account of 
the difference of potential. Differences in sensory effects are 
most manifest in local applications when the higher-poten- 
tial current (positive charge) encounters resistances or attrac- 
tions. The two poles represent chiefly a greater and lesser 
potential of similar current action rather than opposite polar- 
ities. 

I insulate the patient positively, as a general rule, in all 
cases of simple electrification for sedative-tonic effects, unless 
I am treating, for the first time, a new and timid patient 
whose wearing apparel might be "irritating," and whom I 
wish to introduce to the machine in such a manner as to avoid 
the most remote possibility of alarm. 

I insulate all patients negatively for the purpose of giving a 
mild, positive spark. If I am dealing with sluggish, insensi- 
tive, and thickened tissues, requiring the most vigorous and 
stimulating spark that can be applied, without the regard to 
comfort which sensitive tissues would require, I change the 
electrification to the high potential. I insulate all patients 
negatively for an ordinary mild positive breeze effect, and 
only change to positive electrification and negative breeze 
when a counter-irritant effect is desired. 

With smaller apparatus, however, and non-metallic connec- 
tion between patient and machine the results which I thus 
secure cannot be duplicated with negative electrification, be- 
cause the current is not powerful enough. The operator, how- 
ever, can substitute positive electrification when it is necessary. 

Practical Operative Methods.— The greatest perplexity in 
the path of electro-therapeutic development among general 
practitioners is the kaleidoscopic mixture of methods which 
appear to be recommended and which are made still more 



62 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

mystifying by the indefiniteness with which they are de- 
scribed. Special terms have been suggested by diilerent gen- 
erations of writers to indicate some individual and peculiar 
technique. These terms float before the mind of the physi- 
cian in his library and seem to baffle an understanding of the 
subject. Men following the teachings of Remak (who used 
only the galvanic current) and men following the teachings 
of Duchenne (who used only faradic currents) have accom- 
plished wonders in the development of narrow and limited 
methods of application which are utterly useless to the general 
practitioner. 

The joint influences of the teachings of specialists have 
nearly exhausted the art of making electro-therapeutics dif- 
ficult. The attempt to push to its extreme the theory of 
treating a patient with strictly local applications makes it 
necessary to go to a great deal of trouble and enter into re- 
finements of technique which do credit to the ingenuity of 
the school of Duchenne but which are based on mistaken 
judgment. On the other hand, the attempt to recognize the 
soundness of the theory of treating constitutional diseases by 
general electrization, received theoretical justice from some of 
the earlier electricians, but they made the great mistake of 
trying to turn local methods into general in the most diffi- 
cult and tedious way. They ignored the general capabilities 
of the static currents which a previous age had demonstrated 
to be superbly adapted to constitutional treatment, and they 
clung with singular tenacity to the galvanic and faradic cur- 
rents which are best adapted to local applications, and which 
the ingenuity of man cannot transform to meet the require- 
ments of convenient general electrization in office practice. 

No one who is not broad enough to use each separate cur- 
rent for its best purposes can make easy work out of electro- 
therapeutics. The vain effort to fulfil indications with the 
galvanic current alone, as did Remak, or with the faradic cur- 
rent alone, as did Duchenne, or with the static apparatus 
alone, as the men of the eighteenth century were obliged to 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 63 

do, is an act of folly which can lead only to disappointment. 
The electro-therapeutic literature which is filled with unneces- 
sary and in many cases preposterous methods of trying to 
overcome the limitations of a single current and make it an- 
swer for purposes to which another current is vastly better 
suited, makes up an undigested mass of operative technique, 
which distracts the reader and often turns him from the sub- 
ject in despair. 

Now, as a matter of fact, it is only necessary to employ 
each current by such simple methods as prociire the action of 
its best properties to make up a selected sum-total of electro- 
therapy which will be found to possess the great qualities of 
practical simplicity, clinical usefulness and satisfactory results. 
The apparatus which straightens out the bewildering mazes 
of medical writings on this subject, and makes a general elec- 
tro-therapeutic oiifice practice a feasible and satisfactory de- 
partment of medicine, is the static machine. It enables the 
operator to obtain results, to successfully treat a far greater 
number of patients in a given time, and to wholly ignore 
many of the distracting methods of using galvanic and faradic 
currents for work which they are not well able to do. 

It is therefore not my purpose to include in this book every 
method of operative technique that can possibly be described. 
Nor shall I attempt to show how great a variety of methods 
can be incorporated into the uses of a single current. The 
practitioner does not want confusion added to confusion and 
his perplexity increased. What the profession needs is rather 
a simplification of the whole matter along the lines of practical 
technique. 

This is my purpose in writing this book, and it will be 
found that by the use of a few plain and practical methods of 
employing the best therapeutic properties of each different 
current, in its own proper sphere of action, we can arrive at 
results which involve no more trouble than any other branch 
of practice. 

Surgical instruments can often be used in variou' ways to 



64 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

achieve the same end, and so can electric currents. Elec- 
trodes are often but the means of completing a circuit of ther- 
apeutic action and the needed contact can be made as well 
in one way as another out of a choice of several correct 
methods. This, to a great extent, accounts for the endless 
variety of applications described by different authors. It is 
better for us to be guided by a few fundamental principles 
than to memorize a thousand "applications." The well- 
equipped specialist whose work is limited to a narrow field 
may employ a few methods occasionally which the general 
practitioner never needs ; but with these few exceptions I 
shall describe methods which embody the greatest simplicity 
with practical value throughout the therapeutic range of 
electric currents. 

Doubtless the perplexity of the average practitioner who 
rises from the study of various text-books is also increased 
when he examines the catalogues of different makers with the 
view of selecting electrodes. Many of the peculiar electrodes 
illustrated in catalogues are not used at all. Some of them 
have a limited use in the hands of specialists. Others crop 
out of attempts to make a single current do the work which 
must be divided between three currents, and are therefore 
needless to the well-equipped practitioner. 

Satisfactory electrodes may be of a very simple character, 
and so far as it is possible the directions in this book will be 
accompanied by illustrations of the electrodes used. Several 
pages could be filled with cuts of electrodes which have been 
recommended during the past thirty years, and which still 
meet the eye of the physician who consults reference books 
and catalogues, but which are obsolete in practice. 

Length of Seances. — In all electro-therapeutic applications 
of either galvanic, faradic, or static forms of current, the 
length of the sitting is always a factor in dosage. The physi- 
cian will always ask himself what the proper length should be, 
but in the beginning of his experience he may puzzle over the 
answer. 



PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 65 

The fact is that electrical effects are dependent on intensity 
of action, and the time limit must carry these effects to the 
desired point and then stop. Time and intensity are not con- 
vertible terms in the uses of either electricity or heat. 

To illustrate : Take a hot oven that will bake biscuits prop- 
erly in fifteen minutes. Call this unit of heat one, reduce it 
four times and multiply the time the biscuits are in the oven 
by four. One-fourth of sixty minutes is still fifteen minutes, 
but the result will not be a well-baked pan of biscuits. Dur- 
ing their hour's sojourn in the lukewarm oven they would be 
simply dried and unfit to eat. 

Now multiply the unit of heat by four and reduce the time 
limit in proportion, and we would find that the great intensity 
of heat action now going on in the oven would not properly 
cook the biscuits in three and three-quarter minutes, but would 
burn them so they could not be eaten. These principles apply 
to the uses of electric currents in medicine, and the exact reg- 
ulation of intensity and time becomes instinctive with the 
trained operator, although it is exceedingly difficult to write 
directions for the explicit guidance of the beginner. 

What is here said about heat effects relates most closely to 
the chemical polar action of galvanic currents applied with 
bare metal electrodes, but the idea conveyed is applicable in 
principle to all medical currents. 

Stimulation is generally a quick process and the application 
short, for over-stimulation is not desired any more than ex- 
haustive fatigue is indicated when we recommend beneficial 
exercise to a patient. Therefore the application of electricity 
by special methods for the particular purpose of either local or 
general stimulation involves short sittings of a few moments. 

Counter-irritating applications are regulated as to time by 
the same principle and are very short. 

General tonic applications of electricity involve slower-acting 
methods and take more time. Probably fifteen minutes is an 
average length of treatment for this purpose. 

Sedation involves an opposite principle and still slower 
5 



66 PRACTICAL POINTS IN GENERAL ELECTRO-PHYSICS. 

method when the condition attacked is extreme, and present 
relief must not only be obtained but more permanent effects 
aimed at. 

Local circulatory sedation is often as quickly affected as 
local stimulation, but these remarks are directed to neuras- 
thenic and hyperexcitable general states rather than local. 
Time in these cases must be extended beyond short seances, 
and persisted in until effect is secured, whether it takes twenty 
minutes or half an hour. 

In a doubtful case a few additional moments is a safe allow- 
ance, for we cannot over-soothe, over-rest, over-refresh and 
vitalize an exhausted nervous system. 



CHAPTER IV. 

THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

Cells, elements, and switchboards. Portable galvanic batteries. Exciting fluids. 
How to connect a meter in circuit. Milliammeters. Rheostats. Accessory 
appliances. 

Let us now make clear the "physics" of each special cur- 
rent. They are equally simple and can be mastered in a day. 

The practical part of the subject of electro-physics for the 
physician to first understand is how to operate and keep in 
good order his electrical apparatus. The first form of appara- 
tus to consider is the galvanic. 

The galvanic current results from chemical action within 
primary cells. 

The cell of the medical battery consists of an electro-positive 
element (usually zinc) and an electro-negative element (usually 
carbon) contained in a glass jar filled with a solution of salts 
called the exciting fluid. 

The chemical action is the decomposition of the zinc by the 
" excitant " solution in which the zinc and carbon elements are 
immersed. 

The zinc element is amalgamated with mercury to secure a 
uniform electrolytic action upon its surface and prevent irreg- 
ular and too rapid decomposition. Such a cell will produce an 
electric current of the type known as galvanic when conduct- 
ing wires from the two elements are placed in contact, i. e., 
form a circuit. Such a metallic circuit is called a " short cir- 
cuit," and the initial value of the current from a single cell is 
about 1*5 to 2 volts, and from 1-5 to 5 amperes, according to 
the size of the elements. 

For clinical work this enormous amperage is too much and 

67 



68 THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

the voltage far too small, as the moment the resistance of the 
patient enters the circuit Ohm's law divides the voltage of the 
current by the resistance to produce a net current flow for 
medical action. 

To obtain, therefore, an amount of current sufficient for the 
treatment of different patients requiring a wide range of dosage 
(from i-io to 250 milliamperes) to produce different effects 
through different resistances (which may vary from a few ohms 
to nearly 2,000), a considerable number of such cells are joined 
together so that each adds its E. M. F. in a continuous scries 
of increasing volts from the first cell to the last. This arrange- 
ment is called " connecting in series," and no other method is 
employed in any medical battery except a cautery battery. It 
consists of wiring the zinc of one cell to the carbon of the next 
(which is also wired to one of the respective switch buttons of 
the switchboard and its mechanism) throughput the entire 
number of cells in the apparatus. 

For the reason that some applications may require only two 
or three cells, while others may require ten, twenty, or fifty, a 
switch device called a cell selector is provided to switch in or 
out of circuit the exact number of cells we wish to use in a 
given case. For the reason also that galvanic current strength 
must be increased and decreased gradually, a rheostat is 
included in the galvanic circuit in order that the gradations of 
dosage may be free from sudden starts and disagreeable sen- 
sations. Such a current controller is now an essential part of 
a complete apparatus of this kind, and no office cabinet is fitted 
for work without a good rheostat. 

The battery cells are the automatic source of the current and 
generally the invisible part of the galvanic apparatus. The 
switchboard is the mechanical part of the appliance which is 
manipulated by the physician during treatment of patients. 
The operator must therefore be familiar with its management. 
Manual dexterity in this respect is a prerequisite in electro- 
therapeutics, and the necessary skill is quickly obtained by 
practice. Operative directions cannot be given for all switch- 



THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 



69 



boards, as they are not alike in arrangement although they 
must follow definite principles of construction. 

The essentials of a complete high-efficiency galvanic cabinet 
are 50 or 60 large cells, a milliammeter, rheostat, automatic 
interrupter, pole changer, cell selector switch, two terminal 
binding posts, base and auxiliary parts. Several pairs of con- 
ducting cords of copper wire (one pair bifurcated) are necessary, 




• Fig. 2. Complete galvanic cabinet. 

and the outfit of electrodes will grow with time, as clinical 
needs arise. 

It was formerly popular, before the days of improved induc- 
tion coil. apparatus, to include a coil attachment to the gal- 
vanic switchboard. It is sometimes, however, very undesir- 
able to have both these important and very different thera- 
peutic appliances anchored immovably in one cabinet. The 
coil apparatus, when in a separate case, is always portable, and 
in practical work there a+e innumerable occasions when it is 



70 THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

wise to have entirely separate apparatus for each form of cur- 
rent. 

In purchasing a galvanic equipment of the stationary cabinet 




Fig. 3. Galvanic office cabinet containing fifty cells, meter, rheostat andfaradic 

coils. 

type many physicians ask, " Which is the best cell to buy ? " It 
is useless to read descriptions of different cells to form a con- 
clusion on this point. There are several varieties, and new 
ones make their appearance from time to time. The physician 



T?IE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 



71 



has but to go to any one of the best makers of electro-medical 
apparatus to obtain the latest and best. 

Any of the leading cells may be considered adequate for the 
therapeutic requirements of the largest practice, and from 40 
to 60 is a sufficient number. The size of a cell does not deter- 
mine its voltage, and therefore no increase in size will do away 
with need for the number of cells required in all galvanic 
batteries ; but large cells not only provide a greater amperage, 
but possess more capacity and endurance than small cells. 




Fig. 4. Switchboard (Wall cabinet.) 

All improved cabinet batteries are fitted with large cells 
which seldom need renewing and are perfectly satisfactory. 

Workmen for the manufacturer usually set up a new cab- 
inet battery for the purchaser, but if attempted by the physi- 
cian himself, it is important to keep every external surface dry 
and clean. If water is spilled in filling the jars the salts will 
soon creep over the outside. If two bare copper wires are by 
accident left touching each other the cells they join are" short 



72 THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

circuited." This at once creates an excessively rapid chemical 
action, destroys the zincs and precipitates the salts in crystals. 
The fluid is discolored, and a glarice at the cells shows that 
they are " polarized." 

When any unusual deficiency of current strength is dis- 
covered, either by a test or in attempting to treat a patient, 
the operator should look at each cell to detect signs of ex- 
haustion, and if none are discovered the various switches and 
wires should be examined to see if the contacts are all in 
proper order. Accidental polarization ought never to happen 
with a properly set up battery. 

A new cabinet battery in good order should keep so for a 
long time without further attention, and, if restricted to thera- 
peutic uses and not injured by experiments, a good set of cells 
will run about two years without any expense whatever. 
Accidents may impair and the experiments of the beginner 
may shorten the life of any good chemical cell, but when it is 
run down, only the fluid, salts and zinc element need renewT 
ing, and these cost but a few cents. 

Special excitant salts are prepared in packages, each pack- 
age sufficient to charge one cell, and full directions are 
printed on the label, so that no study of this matter is neces- 
sary for the practitioner. 

Portable Galvanic Batteries. — In office work a portable 
galvanic battery is sometimes a convenience, but in general 
practice it is a necessity. It is not, however, the highest type 
of galvanic apparatus and possesses drawbacks. Fluid cells 
are usually employed, as the dry cells which answer the pur- 
pose of broken currents are not satisfactory with the constant 
current. 

To be portable the apparatus must be compact, light, and 
undisturbed by transportation. For this reason the cells must 
be few in number and small in size. From 12 to 24 glass, or 
hard-rubber, cells holding two or three ounces of fluid each 
are generally supplied in the portable case. The apparatus is 
not equipped with meter, rheostat or automatic interrupter, 



THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 73 

and these omissions limit its completeness. It is not a sub- 
stitute for the high-efficiency office cabinet. 

The exciting solution for small portable cells must be more 
concentrated and active than the fluid in large cells, and hence 
it is speedily exhausted and requires to be freshly made at 
short intervals. In this respect the small battery is much 
more troublesome than the large cabinet, which does^not re- 
quire any attention to the cells except at perhaps intervals of 
two or three years, barring accidents. 

When not in use the elements of the small acid battery 
must be invariably lifted out of the fluid or they will corrode 
and waste, while in large alkaline batteries the elements re- 
main immersed all the time without injury. In some portable 
batteries the cells are lifted up to the elements to immerse 
Ihem for action, and in others the elements are let down into 
the cells. The principle is the same in both cases. To pre- 
sent the spilling of the fluid when the case is carried, and to 
separate the cells and elements during non-use, a rubber-cov- 
ered board, called a hydro-stat, is placed between them. 

As the satisfactory use of the apparatus depends upon 
its working order it is necessary to know the best and 
simplest way to clean and refill a battery that has deterior- 
ated. 

First, remove the switchboard with the elements attached. 
They will be found to be dirty and coated with crystals and a 
greenish scum. Let them stand in a pan of cold water plus a 
tablespoonful of salt while making new fluid. Have the water 
reach nearly to the top of the elements but not wet the 
switchboard. Empty out the old fluid from the cells and 
wash them thoroughly. 

Take an ordinary crockery pitcher and put into it four 
ounces of pulv. bichromate of potash. If this is reduced to 
powder it will dissolve more readily than the crude crystals. 
Pour one quart of boiling water into the pitcher ; stir the 
solution a few moments with a wooden stick and set it aside 
to cool. When thoroughly cooled add commercial sulphuric 



74 THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

acid, three ounces, and again set the pitcher aside until the 
heat evolved by the mixture of the acid passes away. 

This part of the battery solution contains nothing to amal- 
gamate and protect the surface of the zinc elements, and mer- 
cury must be added in some form to make it effective. Crude 
mercury cannot be used in solution, and if the usual bisul- 
phate is added to a cold fluid it will not dissolve. The best 
method known to me is as follows : 

Take Nitric acid (commercial), 3 iv. 
Muriatic acid, | iss. 

Bisulphate of mercury, § i. 
Place these together in any small bowl or pitcher and care- 
fully heat in a water-bath. _ Heat and stir until the mercury is 
dissolved, then set aside to cool. When cool add two ounces 
of commercial muriatic acid. This formula prepares four 
ounces of a mercuric solution which will keep until used, and 
a fresh supply need only be made at long intervals. 

When the bichromate solution is thoroughly cool, add four 
drams of the mercuric solution and the complete excitant is 
then ready to pour from the pitcher into the cells of the port- 
able battery. If the capacity of these cells is greater or less 
than one quart the quantity may be varied to suit. Each cell 
should be filled only about two-thirds full to allow room for 
the immersion of the elements without causing an overflow. 
The bichromate part of the solution must be freshly prepared 
whenever the cells are run down, and with some little daily 
use of the apparatus this will occur about every three to six 
weeks, although the endurance of the cell will vary according 
to use and care. The mercuric solution should only be added 
to the freshly made fluid when ready to put into the cells. 

The separate steps of mixing fresh battery fluid require but 
a moment's time, although twelve or twenty-four hours should 
be allowed for cooling before the elements are immersed. 
Never use a fluid so recently prepared that it is still warm, as 
it would attack the elements too rapidly and waste its strength. 

Meanwhile the zincs and carbons have been soaking in the 



THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 75 

strong salt solution where they were placed when we began to 
mix the fresh solution. The water around them is now seen 
to be discolored a greenish hue, and a sediment has collected 
in the bottom of the ' pan. Lift the elements from the salt 
solution, rinse them with plain water and wipe them thoroughly 
with a soft rag. When as clean as they can be made they are 
ready to return to the apparatus. The process is then com- 
plete. 

Although small portable galvanic batteries are not con- 
structed with a milliammeter or a rheostat, yet they are ar- 




Fig. 4a. A compact portable galvanic battery containing sixteen cells. 

ranged so that the current strength is increased by a single 
cell at a time, and this answers instead of a current controller 
for many ordinary external applications with medium or large 
electrodes. 

Refinements of treatment, however, require refinements in 
methods and apparatus. A meter should invariably be sup- 
plied in the circuit by the physician. It is easily done. Sim- 



"je THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

ply place a portable milliammeter on the table beside the 
battery and level it with the needle pointing at zero. Connect 
a short wire between the positive pole and one binding post 
of the meter. To the other binding post attach the conduct- 
ing cord from the positive electrode. Connect the other elec- 
trode to the negative pole of the battery in the usual manner. 
When the electrodes are applied to the patient and the battery 
started into action the meter will be interposed in the direct 
pathway of the current, so that it will register the amperage 
flowing through it as if it was a fixed part of the apparatus. 

The question may be asked, " Upon which binding post of 
the meter to attach the wire from the battery ? " With some 
meters it makes no difference, but if any physician finds that 
his own instrument does not work properly when connected 
in one way it is a simple matter to transfer the connections. 
It will simplify many of the questions which perplex the be- 
ginner in the uses of medical electricity to remember that 
there are only two poles to a switchboard, and if one is not 
right the other must be. 

Milliammeter. — In general estimation the rapid progress of 
galvanic therapeutics during the past ten years is ascribed to 
the accuracy in dose measurement afforded by the milliam- 
meter. It is this single instrument of precision, adopted 
universally within half a decade, which is said to have lifted 
the galvanic current from the uncertain methods of empiricism 
and given scientific exactness to its employment. This in- 
strument is a calibrated " galvanometer," which had its origin 
in Oersted's discovery, in 1820, that a freely suspended needle 
is deflected by the passage of a current of electricity in its 
neighborhood. When milliammeters began to be more gener- 
ally employed by physicians, and prior to 1893, few of them 
were accurate instruments of precision. Some of them would 
register from seventy-five to more than a hundred mil. when 
the actual current was less than fifty. Much of the unreliabil- 
ity which the expert recognizes in pubHshed reports about 
current strength has been due to differences in meters. 



THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 'J'] 

The meter indicates the " amperage" (or rate of flow) of the 
continuous galvanic current. This current is silent in its flow 
and physiological activity. Without an indicating instrument 
we may be in doubt whether or not the battery is in action 
until the current is strong enough to be felt by the patient, 
and as a guide to therapeutic doses the patient's sensations are 
very incompetent. 

Owing to the feeble power of E. M. F. possessed by the 
constant current, an enormous range of uncertainty enters into 
every galvanic application without a standard meter in the 
circuit ; for the actual current strength, from the same number 
of cells and with the same electrodes, will vary greatly with 
the degree of resistance of the skin, so that similar conditions, 
such as using the same number of cells as for a previous treat- 
ment, are no guide whatever to similar doses and effects at 
the next treatment. If two physicians simultaneously con- 
ducted the same application with exactly similar apparatus, 
upon exactly the same tissues, the single difference of wetting 
one set of electrodes with plain hot water and in the other 
case adding about two per cent, of bicarbonate of soda would 
make such a difference of dosage as to be incredible to any 
one unfamiliar with the subject.. The actual value of the 
dose in each case can only be determined by the milliammeter, 
and this fact renders it indispensable. 

Meters may be portable, or attached permanently to the 
switchboard. They are made to read with various scales for 
large or small currents, and stand in either an upright or hori- 
zontal position. The perpendicular scale is the most conven- 
ient to read while treating a patient. A balance meter will 
often over-bank if the poles are reversed suddenly, and cannot 
be made accurate. 

The best meters are of the permanent magnet type. A 
meter that is not standardized and guaranteed to be accurate 
by a reliable maker is not a suitable instrument for medical 
use. Some meters which are accurate at the beginning grad- 
ually lose their magnetic saturation and require to be standard- 



;8 THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 




Fig. 5. Milliampere-meter. 

ized again after a few years. Cheap meters are a dear invest- 
ment at any price. The most satisfactory meter in my own 
equipment is illustrated in the accompanying figure. It never 
fails to act properly. The needle never sticks. It needs no 
tapping to start the pointer. It does not over-bank when 
polarity is reversed. It is exceedingly sensitive and possesses 
a dead beat attachment so that the needle can instantly be 
brought to rest by pressing a knob. By a turn of the same 
knob the needle can be locked, and when a portable form is 
employed this permits, transportation without injury. The 
magnets are permanent and obviate future calibrations. It 
possesses a double scale reading from zero to fifty mil. for 
small currents, and from zero to two hundred and fifty mil. 
for larger currents. It is in all practical ways a fine and re- 
liable instrument and is handsomely mounted. I am perfectly 
satisfied with it. 

Rheostat. — The current controllers, of improved form for 



THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 79 

use with galvanic currents, are chiefly of two types, one of 
which is dry and the other wet. Both serve for the satis- 




Fig. 6. Graphite current controller. 

factory regulation of current strength, and each possesses ad- 
vantages and minor drawbacks. A water rheostat requires to 
be refilled, and a carbon rheostat also requires occasional atten- 
tion. A rheostat is indispensable, and the physician may be 
certain of obtaining a satisfactory instrument from any reliable 
dealer, as thei^e are a number of varieties in the market. 




Kg. 7, The new Bailey current controller. 



8o THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 

Being simple in construction, they do not present the difficul- 
ties which enter into the making of a reliable milliammeter. 

This instrument consists of two triangular-shaped carbon 
plates, each carrying a conical sponge at one of its angles, and 
mounted over a glass vessel containing water. By means of a 
worm gear, operated by a thumb knob, the sponge tips are 
gradually immersed into the water and towards each other. 
This current controller, or rheostat, will increase the current 
without variation or fluctuation. 

Accessory Appliances. — There are a number of small acces- 
sories required for complete electrical equipments. Controlling 
and regulating devices, conductors, electrodes, and various other 
conveniences are provided in patterns which differ somewhat, 
according to the ideas of the maker or buyer. 

Petty annoyances are oftentimes serious obstructions to 
what might otherwise be the most efficient and desirable 
methods of treatment. A disagreeable shock to a patient, or 
a failure in getting a current at a critical moment, when 
neither the time nor the occasion is suitable for searching out 
the cause, has induced many a physician or surgeon to 
abandon electricity as an aid to therapeutics when no other 
agent would serve him so well. The loss of a binding screw 
or a defective cord conductor may prove as vital to the suc- 
cess of electro-therapeutic work as a broken coupling pin to the 
proper running of a moving train of cars. Any improvement, 
therefore, which will avoid such obstacles in the practical 




Fig. 8. Convenient connectors. (Mcintosh.) 



THE ESSENTIALS OF GALVANIC ELECTRO-PHYSICS. 8 1 

workings of electro-therapeutic apparatus is a blessing to both 
physician and patient. 

A very simple and efificient substitute can be adopted for the 
old form of connection by which all of the annoyances inci- 
dent to it can be avoided. By the use of a universal spring slot 
connector, such as is shown in Fig. A, a perfect contact can 
be readily made with corresponding simple terminals on bat- 
teries and electrodes. For some time spring slot connections 
have been made, both for cord tips (as B) and electrodes, but 
the universal connector takes the place of all these special 
devices, and at the same time greatly simplifies the construc- 
tion of electrodes and battery contacts. 

£ 

Fig. 9. 

C. Universal Cord Tip Connector, to connect cord tips of 
any battery. 

E. Universal Electrode Connector, to connect cord tips of 
any battery with Electrodes. 

D. Double connector, for wire or cords. 



|mM^j[u[H nno[ffl!in!ffl![B. hii..--> 





Fig. 10. Adjustable cord tips. 

Up-to-date information in regard to all accessories may 
always be found in late catalogues of leading manufacturers, 
and need not be copied into a book of this kind. 

Having practised the technique of managing a galvanic 
switchboard, let us see in the next chapter what effects we 
can produce with this form of apparatus. 



CHAPTER V. 

PHYSIOLOGICAL AND THERAPEUTIC ACTIONS OF GAL- 
VANIC CURRENTS UPON AND WITHIN LIVING TISSUES. 

The influences of the constant galvanic current upon and 
within living tissues in health and disease are those which result 
from the electro-chemical and dynamic actions of a (medically) 
large volume of electricity without much pressure behind it to 
impart mechanical force. The medical properties of all currents 
alter in proportion to the relation between their voltage and 
amperage, and when one is high and the other low the effects 
of one predominate at the expense of the other. Amperage is 
the predominating factor in galvanic currents, and in medical 
uses only sufficient voltage is present to push the desired 
number of milliamperes through the tissues. 

Medical galvanic currents may be either continuous or in- 
terrupted, but are almost wholly employed in their constant 
form. 

The constant galvanic current possesses complex polar and 
inter-polar properties which are generally grouped under four 
heads, — cataphoric, electrolytic, catalytic and electro-tonic. 
These conventional terms merely represent various sides of a 
complex influence of currents according to the nature of the 
tissues acted upon, and are not distinct and independent prop- 
erties although any one of them may be made to become the 
predominating therapeutic action during treatment. 

When the semi-solid substance of muscle or the fluid con- 
stituents of the body are subjected to the inter-polar action of 
a constant galvanic current of sufficient strength, there is an 
osmotic and cataphoric determination of the products of 

electrolytic action from the positive electrode toward the site 

82 



ACTIONS OF CURRENTS UPON LIVING TISSUES. 83 

of the negative electrode. From this osmosis results phys- 
iological effects which are fluid lessening, anti-congestive and 
denutritive at the positive pole, and fluid increasing and con- 
gestive at the negative pole, with ordinary protected electrodes 
and mild dosage. The lessening of the capillary fullness at the 
positive electrode will also be sedative in congested conditions 
with their accompanying pains, and the increased capillary 
blood supply at the negative region will be locally nourishing, 
stimulating, derivative and alterative in the opposite patho- 
logical states. 

Degrees of these effects will be regulated by the current 
dose. The intensity of drug action depends upon the drug 
dose, the effects of heat depend upon the degree and manage- 
ment of the temperature, the effects which may be produced 
by a main of water are limited by the pressure and volume of 
the current, and degrees of intensity in the effects which 
electric currents are caused to produce are regulated by similar 
principles of managing this agent. Every added milliampere 
in a galvanic medical current represents an increase in the rate 
of flow, the volume and pressure force of the current, with a 
corresponding intensification of its processes of dynamic action. 

When the compound saline fluids and semi-solid tissues of 
the body are subjected to the direct polar action of a medical 
galvanic current by the metallic contact of electrodes the 
modifying and protecting influence of felt, absorbent cotton, 
sponge and other coverings isremovedand the full phenomena 
of polar electrolysis takes place. At the positive pole the 
chemical decomposition liberates the oxygen and chlorine of 
the tissues and collects acids (sulphuric, nitric, hydrochloric, 
and phosphoric), and hence blanches, hardens and dries in 
proportion to the electrolytic activity. 

Thus, in hemorrhagic states, it is the contracting, astringent, 
coagulating and drying pole. With a mild current this local 
polar action is simply styptic ; with a stronger current it is a 
chemical hemostatic ; with a still higher intensity (above about 
thirty milliamperes) it is chemically caustic, and in higher doses 



B4 ACTIONS OF CURRENTS UPON LIVING TISSUES. 

of from 50 to 150 milliamperes it produces more and more 
active actual cauterization as the intensity rises. The positive 
current attacks metallic electrodes with electrolytic action, 
forms new double salts with the nascent base, pushes these 
products into the tissues by osmotic and cataphoric action, and 
is therefore the polar influence employed in most of the various 
forms of cataphoric medication and metallic electrolysis. 

The negative polar influence, on the contrary, under the same 
circumstances of application, liberates hydrogen and attracts 
the alkalies of the body fluids (sodium, potash, lime, ammonia), 
and hence has a softening, liquefying, hemorrhagic action. 
The negative pole, therefore, electrolyzes, softens, relaxes and 
congests in moderate doses, becomes caustic in larger doses, 
and finally also cauterizes under the contact of a bare metal 
electrode. The scar of a negative burn upon the skin is pink 
and soft, resembling that of an alkaline caustic, while the scar 
of a positive cauterization upon the skin is white and hard, re- 
sembling that of an acid caustic, but burning is not a part of 
the therapeutic uses of either pole. For actual cautery work 
another apparatus is employed. 

The electrolytic power to decompose metallic and organic 
compound substances gives to the polar action of the galvanic 
current a valuable diversity and wide range of action, for we 
have not only two opposite polarities and a variety of metallic 
electrodes which deposit antiseptic, astringent and alterative 
salts within the tissues, but we graduate the action, both in 
kind and degree, by the intensity and duration of the current 
flow. We can regulate the dose exactly. 

Catalysis was a term applied by Remak to the properties of 
galvanic current action in general which supplement cata- 
phoresisand electrolysis by dilating the blood vessels and lym- 
phatics, stimulating glandular secretion and increasing the 
powers of absorption and osmosis in the negative region, and 
doing the reverse in the positive region. 

In addition to these effects Remak included under the term 
catalysis the influence of the galvanic current upon molecular 



ACTIONS OF CURRENTS UPON LIVING TISSUES. 85 

exchange and nutrition due to exciting (or soothing) the nerves 
themselves, or the parts which they supply ; also the changes 
in the molecular arrangement of protoplasmic structures and 
in their nutritive activity produced at the same time, and, 
finally, the consequences of the mechanical transference of 
fluids and salts from the positive towards the negative pole. 

While electrolysis is the prominent local polar effect the term 
fa/a/j/.fzj conventionally indicates the general alterative, electro- 
tonic and electro-sedative inter-polar actions of the galvanic 
current. These actions affect nutrition — increase it in mod- 
erate dosage and decrease it in excessive dosage. 

With every galvanic application in a continuous form there 
is some effect upon both striated and non-striated muscular 
fibres. This increases with the amperage and voltage until a 
tetanic contraction is set up at the positive pole. The electro- 
tonic action throughout the positive path of the continuous 
current decreases muscular excitability and soothes an irritable 
nerve. . In the negative part of the current muscular and 
nervous irritability is increased. 

All nerves of special sense are excited by the passage of a 
galvanic current through or near them. Its flashes of light 
and metallic taste are familiar to all. 

When the galvanic current is interrupted its electrolytic 
action is interrupted, but muscular contractions are produced 
which are effective in dispersing the products of previous elec- 
trolysis, and which possess a greater influence in promoting 
the nutrition and function of paralyzed muscles which have 
undergone atrophy and degeneration than the contractions 
produced by induction coil currents of higher voltage but of 
very much less amperage. 

The galvanic current may be interrupted by an automatic 
rheotome with varying rates of rapidity, but in practice we 
require to employ only rates of from about 70 to 100 per min- 
ute for muscular exercise, or a rate of 300 or 400 per minute 
for local massage effects. Rapid interruptions such as are 
produced by the rapid vibrator of a fine induction coil appara- 



86 ACTIONS OF CURRENTS UPON LIVING TISSUES. 

tus are not practical with galvanic currents, and single impulses 
are made by hand, so that the automatic rheotome is chiefly 
employed for medium and low rates. 

With the constant current a low amperage and medium or 
large electrodes, covered with some protecting material, are 
employed in ordinary external applications when we wish to 
produce chiefly the effects which have been called catalytic, 
but which it seems more rational to call nutritional; for we 
desire these effects when we seek to improve nutrition, 'pro- 
mote circulatory energies, vitalize the nervous system, build 
up atrophied muscles, stimulate glandular and nerve cells, and 
" assist nature to restore the sound state." In these cases the 
dose will usually range from five to twenty milliamperes with 
small or medium electrodes, and with larger electrodes may 
be increased from 30 to 60 milliamperes without much altering 
the current density. 

In metallic electrolysis and cataphoric medication with the 
positive pole we must employ sufficient density to accomplish 
results, viz., to decompose the metal and push the medication 
into the tissues. In addition to the chemical action of amper- 
age it is also here a matter of voltage against resistance. The 
current strength required for these purposes will vary accord- 
ing to the conditions of the application, the size of the elec- 
trode and the degree of effect desired. The meter will 
register from 5 to about 20 milliamperes in different cases 
with different sizes of electrodes. See section on these sub- 
jects for fuller details. 

In negative electrolysis for the softening and relaxing of in- 
durated, contractured or cicatricial tissues, to resolve exudates 
and prortiote absorption, the external dosage with protected 
electrodes will follow the usual rule of current density up to 
comfortable tolerance of the patient, and this tolerance may 
be greatly increased by proper preparation and application of 
the electrodes, as will be described hereafter. 

With bare metal electrodes employed to dilate a mucous- 
lined canal a strong current would defeat the object and 



ACTIONS OF CURRENTS UPON LIVING TISSUES. 87 

moderate currents are more effective. A current of from five 
to fifteen milliamperes will correct an ordinary stenosis of the 
uterine os and facilitate drainage in a way that no other 
method can equal in cases to which it is suited. 

The destruction by negative electrolysis of small growths 
upon the skin or mucous membrane is performed with fine 
needles or broaches of such limited surface area that the cur- 
rents employed seem to be very small, but they represent 
nevertheless a high density. One half a milliampere will cause 
an intense liquefying action at the point of a small needle in a 
hair follicle, and two or three milliamperes will quickly pro- 
duce sufficient action for the destruction of a small naevus. 
To appreciate the active character of such a dosage we have 
only to multiply the amperage by the greater contact area of 
any large electrode. 

It is chiefly in gynecological work that the greatest range of 
current strength is employed, and the application of more 
than 50 milliamperes is almost exclusively limited to this field 
and to joints and tumors. In intra-uterine applications with 
bare metal electrodes nutritional, sedative, tonic, alterative, 
stimulating and other effects below caustic electrolytic action 
are secured with doses ranging from zero up to about 30 mil- 
liamperes. 

Galvano-caustic effects require a range of dosage from 30 to 
about 75 milliamperes, depending somewhat upon the state of 
the tissues, duration of treatment and the size of electrode. 

Cauterizing effects for the gross destruction of tissues which 
is desired in the treatment of fibroid tumors demand intensities 
usually ranging from 80 to about icxd milliamperes in ordinary 
practice, with sittings of from ten to fifteen minutes in length. 
In special cases and for two or three minutes only the amper- 
age is carried up to 150, in rarer cases up to 200, and occa- 
sionally up to 250 milliamperes. The highest rates are now 
less used than formerly, and early reports of the. use of from 
one to three hundred milliamperes are no guide to the actual 
facts, unless we know that the meter registered accurately. 



88 ACTIONS OF CURRENTS UPON LIVING TISSUES. 

Many of the cheap meters employed to-day and almost all th 
meters that were employed previous to a very recent tim 
fluctuated in their measurements and often recorded a greate 
current than was employed. 

The therapeutic possibilities of galvanic currents are com 
prised within the following limitations of operative tech 
nique : 

1. The application can only be either a constant or inter 
rupted current. 

2. The active polarity must either be positive or negative 
or may alternate. 

3. The application must be local or general, and if the latte 
it is usually the single method called central galvanization. 

4. The polar or inter-polar properties of the current may b( 
made to predominate within the tissues treated. 

5. Covered, or bare metal, electrodes of different sizes 
shapes and material may be employed, labile or stabile. 

6. Medication by either cataphoric methods or metalli( 
electrolysis may be added to current action upon mucoui 
membranes and within soft tissues, and all soluble remedie: 
may be driven into or through the skin. 

7. Each local or general effect of the galvanic current maj 
be increased or diminished by regulation of the current den 
sity and duration of sitting. 

This surveys about the whole field of galvanic technique, i 
we include needle puncture among the uses of bare meta 
electrodes. 

Synopsis of Constant Current Properties in Clinical Ap 
plications. — Positive polar action with protected electrodes 
sedative to nerve irritability,, tonic to nerve and muscle fibre 
anti-congestive, osmotic, pushes fluids towards negative elec 
trode. Strong currents produce counter-irritation, heat anc 
pain beneath the electrode, and will finally vesicate. 

Negative polar action with protected electrodes: increase; 
nerve excitability, relaxes fibrous tissues, attracts fliuids fron 
the positive pole. 



ACTIONS OF CURRENTS UPON LIVING TISSUES. 89 

General inter-polar action : Nutritional, electro-tonic, sed- 
ative, anodyne, alterative, warming, refreshing, vitalizing. 
Electrolytic action is modified and special effects depend upon 
relation of electrodes, state of tissues, strength of current and 
time of current flow. 

Positive local polar action with non-attackable bare metal 
(platinum) electrode within soft tissues : 

With mild currents, sedative, tonic, nutritional, anti-con- 
gestive, astringent, . hemostatic, muscle-contracting, mildly 
osmotic, cataphoric and electrolytic. 

With medium currents, styptic, coagulating, drying, shrink- 
ing, muscle-contracting, anodyne, denutritive, anti-hemorrhagic, 
antiseptic, osmotic, cataphoric and electrolytic in proportion 
to current strength. 

With strong currents, blanching, drying, denutritive, coagu- 
lating, hardening, muscle-contracting, antiseptic, germicidal, 
cataphoric and caustic, rapidly increasing to cauterization 
with gross destruction of tissues as amperage increases. The 
positive cautery scar contracts. 

Negative local polar action with any bare metal electrode 
within soft tissues : 

With mild currents increases capillary circulation and nerve 
and muscle excitability ; mildly osmotic and electrolytic ; 
alterative, relaxing, dilating, nutritional, healing to ulceration. 

With medium currents more actively congesting, softening, 
nutritive, osmotic, and electrolytic. 

With strong currents, liquefying, hemorrhagic, escharotic, 
leaving a soft pink scar. High-intensity, cauterizing currents 
break down indurations, and cause gross destruction of tissues. 

Positive local polar action with copper, zinc, silver and other 
bare metal attackable electrodes : Medium currents decom- 
pose and deposit oxychlorides of the metals within the tissues 
surrounding the positive electrode. The eiTects are anti- 
septic, germicidal, anti-hemorrhagic, drying, styptic, astringent, 
tonic, nutritional, alterative, curative of catarrhal inflamma- 
tions of mucous membranes. 



90 ACTIONS OF CURRENTS UPON LIVING TISSUES. 

Negative local polar action with similar electrodes does n 
attack the metal, and, therefore, is limited to the properties 
the current alone. 

Other actions and refinements in effects which accompar 
or are produced by skilful technique and regulation of dc 
age are too complex for verbal description. Therapeutic a 
tions which can easily be demonstrated are difficult to d 
scribe, for like harmonious sounds or shades of color the 
merge into the indefinite where language cannot follow thei 

Having familiarized these effects and practised how to pr 
duce them, we are prepared to employ galvanic currents : 
clinical work. 



CHAPTER VI. 

CAUTERY APPARATUS. 

Cautery Apparatus. — When the term cauterization is used 
in connection with medical applications of the galvanic cur- 
rent passing through' tissues between two separate electrodes 
a chemical action is referred to which is entirely different 
from the searing process of a platinum knife, or wire, heated 




Fig. II. Handle for holding cautery burners : — with interrupter. 

to a cherry red or white heat, by a concentrated current with 
an amperage from 20 to 100 times greater than a medical dos- 




Fig. 12. Cautery burners flexible, for curving, etc. 

age. In cautery work the electricity is not applied through 

tissues between two electrodes but is used to heat one electrode 

and to burn superficially. 

91 



92 CAUTERY APPARATUS. 

Every physician must understand that the cautery battery 
is an entirely distinct apparatus from all medical forms. It 
embodies the principles of the ordinary galvanic battery, but 
is constructed in a special manner for the sole purpose of 
developing amperage, almost without voltage, so that the cur- 
rent will achieve the great object of supplying heat. 




Fig. 13. Cautery battery. 

An induction coil battery cannot be used for cautery work. 
An ordinary galvanic battery is not employed for cautery 
work, and a cautery battery is never employed for galvanic and 
faradic applications with electrodes in the ordinary manner. 

By means of large elements connected in a manner some- 
what different from the series connection of medical galvanic 



CAUTERY APPARATUS. 



93 



cells, a small number of primary cells serves the purpose of a 
cautery battery. Secondary storage cells are employed for 
the same purpose when (rarely) it is convenient to do so, or 
by means of special controllers the street current is utilized to 
heat the cautery burners. 

Physicians often inquire which is the best method to em- 
ploy, or which is the best kind of a battery for cautery work. 




Fig. 14. A form of cautery battery for light work. {^Kidder. Mfg. Co.) 

Much dissatisfaction has also been expressed by those who 
have purchased cautery batteries from surgical instrument 
makers or small irregular dealers. I consider it unnecessary 
to refer to text-books for advice on such points. The best 
information can be obtained by examining the apparatus of 
the best makers. There are several long established and 
reliable manufacturers who devote themselves especially to 



94 CAUTERY APPARATUS. 

electrical apparatus for medical and surgical use. They are 
much better authorities to consult than jobbers in other goods, 
and up-to-date information can be obtained from them at all 
times. Improvements are gradually taking place in the con- 
struction of primary cell apparatus and in controllers for using 
the street current, and full particulars can always be obtained 
from the leading manufacturers? While the author is per- 
fectly impartial in all matters relating to the commercial side 
of electro-therapeutics, yet it must candidly be said that it is 
an unwise policy for physicians to attempt to buy electrical 
apparatus from dealers who are in a miscellaneous business. 
Batteries with unknown names attached to them are often 
disappointing. High efficiency apparatus can best be ob- 
tained from houses who not only devote their entire attention 
to this branch of manfacture, but who have for many years 
derived the advantage of constdtation and advice from the lead- 
ing workers in the field of electro-therapeutics. 

Commercial electrical dealers obviously lack this important 
advantage in the construction of medical apparatus. 



CHAPTER VII. 

THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

The transforming device. Difference between galvanic and faradic currents. 
How to test " high tension " induction coil apparatus. Quality tests for fara- 
dic interrupters. The author's apparatus. Recording the dose of faradic 
currents. 

The Essentials of Faradic Electro-Physics. — A single read- 
ing of summarized facts about faradic batteries will inform the 
practitioner on essential points. 

" Faradic " currents are the product of mechanical devices 
which transform the direct electrical output of chemical cells. 
They involve the process called induction. An induced current 
of electricity is generated in a closed wire circuit placed near 
to, but not in contact with, another circuit through which a 
current is passing. 

The continuous electrical current, now named in honor of 
Galvani, is directly conducted from the generating battery cells 
to the electrodes applied to the patient, without first passing 
through any mechanical device which modifies its character 
and action. 

The mechanism of a galvanic battery has already been de- 
scribed. Let us now note the difference in mechanism which 
is required to modify the primary cell current so as to transform 
its character, action, voltage, and amperage. 

We take one, two, or more of the same primary cells and 
simply divert their electrical out-flow to, and through, a device 
upon the switchboard of the apparatus before we conduct it 
beyond the apparatus to the patient. . This mechanical device 
alters the direct galvanic into a faradic induced current, and 
the galvanic battery into a faradic battery. 

95 



96 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

It consists of two essential parts: an induction coil and an 
interrupter. In their commonest forms both are familiar 
objects to all who have ever seen a " family battery," but to 
possess therapeutic value they must be quite a different matter 
as respects construction and quality. 

In a faradic apparatus the primary cell current passes along 
a conducting wire to, and through, the coil of copper wire 
wound spirally around the bundle of iron rods which constitutes 
the magnetizable core of the primary induction coil. From the 
moment the primary current is modified by this primary coil, 
it ceases to be a galvanic current and becomes an induction 
current. The distinction between these two cannot be too 
clearly understood, and it is referred to in a previous chapter. 

Meanwhile a second conducting wire from the opposite 
element of the cell conveys the current to the second com- 
ponent part of the faradic transformer, which is the interrupter. 
This is usually of the spring vibrator type, which is too familiar 
to need description. 

The head of the free end of the spring approaches the attract- 
ing end of the magnetized iron core in front of it when the 
current acts through the coil. The reverse surface of the spring 
presses against the stationary platinum point when the current 
stops and the magnetic core ceases to attract. There can 
therefore be no faradic type of current without the succession 
of "makes and breaks" set up by this method, and this con- 
stitutes one important difference between coil and cell currents. 
This interruption is accomplished automatically in medical 
batteries through the operation of the law of electric attraction 
and repulsion. " Like poles repel and opposite poles attract 
each other." 

However, the device must do more than merely " interrupt " 
to transform a galvanic current into an induction coil current, 
for the primary cell current is often employed in treatment 
with an interrupter in the circuit without losing its galvanic 
characteristics of very small voltage and comparatively large 
amperage. What the coil does is to practically transpose these 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 97 

relations of voltage and amperage. The current comes out of 
the first coil with much higher E. M. F. than it went in, and 
with its amperage reduced to a very small value ; and when a 
second induction coil is placed over the primary coil the second 
inductive process carries the current to a still greater height of 
voltage, and proportionately attenuates the current volume. 

The degrees of alternation by different coils are regulated for 
medical purposes by varying the diameter and length of the 
wire employed, and by making a greater or less number of 




Fig. 1 5, represents a single vibrator faradic battery of low price for external appli- 
cations. It is not designed for fine and sedative applications, but is equal to any 
battery below the high grade. It has an excellent coil of 4500 No. 32 wire tapped 
in three places. 



turns in winding. The aggregate of these turns in the com- 
pound coil of the author's apparatus is above 15,000. 

While all galvanic currents of equal voltage and amperage 
are alike in quality and therapeutic action, regardless of the 
particular style of apparatus from whence they are derived, the 
7 



98 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

same is not true of faradic currents. Induction coil currents 
not only depend for their best qualities upon the best ap- 
paratus, but are only, obtained when the apparatus is in proper 
working condition and adjustment. It is important to recog- 
nize the fact that there is no standard of high-efificiency cur- 
rent common to all faradic batteries. All single coil, single 
vibrator, and single cell, faradic batteries (of which there are 
thousands in popular use) belong to a class of low efficiency 
appliances altogether outside the sphere of genuine electro-thera- 
peutics. 

A medium grade of faradic batteries, ranging between about 
twenty and forty dollars in cost, will perform satisfactory 
therapeutic work of a limited variety and chiefly for gross 
effects upon the external surface of the body. It is only 
when we go a little beyond this limit of cost and procure a 
high efficiency apparatus equipped with compound coil, ample 
E. M. F., finely adjustable rapid and slow vibrators, rheostats 
for current control in both primary and secondary circuits, 
pole changer, and switches for the simple, convenient, and 
rapid adjustment of all gradations of different dosage, that wc 
secure the means of obtaining the best results throughout the 
whole range of modern faradic therapeutics. With a little 
care and attention to adjustment such an apparatus is always 
in working order for every form of application in either gen- 
eral or special practice. 

How to Test High Tension Induction Coil Apparatus.— 
Since the discovery, chiefly made known within the past few 
years, of the important therapeutic effects dependent upon 
the quality in induction coil currents which is called " high 
tension," the ordinary forms of coils long furnished with com- 
mon faradic batteries have become obsolete. Their field of 
action is limited to less than one-fifth of the therapeutic work 
of the improved apparatus, and they are wholly unsuited to 
the treatment of pelvic diseases, which constitute now the 
most important localized field in which coil currents are em- 
ployed. Separate apparatus for coarse external work and the 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 99 

finer needs of the gynecologist are riot required, for the best 
apparatus does all varieties of work. 

The term higfUension is merely a conventional one applied 
to induction coil currents which possess a very small amperage 
and a much higher voltage than ordinary coil currents. Fine 
wire wound with many turns producing high potential and 
low amperage are the special features of these coils. 

The three factors which produce the special sensory, vaso- 
motor, and motor effects of the modern improved faradic ap- 
paratus are high potential, low amperage, and rapid, smooth 
interruption at the rate of from 15 to 30,000 periods per 
minute. 

With one such apparatus at hand no other kind of faradic 
battery is needed for any work which coil currents can per- 
form, for the greater includes the less, and the scientifically 
constructed coil displaces all former and crude varieties. 
Even the best apparatus is now quite inexpensive. 

Every physician may determine, to his own satisfaction, 
whether the apparatus he possesses fulfils the requirements 
of therapeutic coils. 

Select a moderate size Geissler vacuum tube, about three or 
four inches long, which can be bought of dealers for less than 
one dollar. Connect the two terminals to the opposite poles 
of the faradic battery by any short pieces of copper wire. 
Start the current into action with either the rapid or slow 
vibrator. If the coil is one of the ordinary type the full 
E. M. F. of all the cells will produce no luminosity in the tube. 
This test should be made in a darkened room. If the longest 
and finest coil in the apparatus fails to glow the tube with the 
greatest E. M. F. of the battery, it is proof that the quality 
which is called high tension (or high potential) is not con- 
taineH in the current of the coil so tested. 

If, however, the coil contains sufficient fine wire to produce 
the resistance which creates high potential, and is properly 
wound and constructed, the tube will glow during the passage 
of the current. At least 4,500 feet of No. 32 or 36 wire ap- 



lOO THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

pears to be necessary to glow a tube. The higher the poten- 
tial of the current the brighter the luminosity. With the full 
length of the compound Kidder coil (containing nearly 8,000 
feet of wire with over 15,000 windings) we obtain a very 
beautiful effect within the Geissler tube, and each coil is 
standardized by this means by the makers. 

When the potential of the coil is carried immensely higher 




Fig. 16. 

A high tension compound coil apparatus with primary circuit rheostat. 

(J. Kidder Mfg. Co.) 

by using a large amount of wire — far more than medical coils 
contain— we have the means of exciting Crookes tubes and 
producing X rays. The only reason medical coils will not 
glow Crookes tubes is lack of sufficient potential to complete 
the circuit through the resistance of the high vacuum. 
Geissler tubes possess a very low vacuum, as all physicians 
are aware. 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. lOI 

Three Tests for Faradic Interrupters — Refined therapeutic 
effects and the satisfactory use of rapidly interrupted high 
tension induction coil currents depend upon the constancy, 
evenness, and fineness of the vibrator action. It is essential 
to know what standard of quality a current should possess in 
these respects. Competent tests are afforded by eye, ear, and 
tactile sensation. 

1. Geissler tube test. Connect the opposite electrodes of 
any small Geissler tube to the terminal ppsts of the battery 
by any short copper wires. Switch at leas,t 4,500 feet of coil 
into the circuit, or better still, the entire length of the longest 
coil in the apparatus. Test the adjustment of the rapid vi- 
brator with E. M. F. varying from one to four or more cells. 
Make the test with the tube in shadow or in a darkened room. 
If the vibrator action is uneven the fact will at once be appar- 
ent in the luminous effects through the tube. The wavy 
motion of the discs will be irregular and jerky. When the 
proper adjustment is finally made the vibratory motion of the 
discs will be regular and constant. 

2. Telephone test. Connect a telephone receiver to the 
terminals of the battery by a pair of the usual conducting 
cords. Place the receiver to the ear. Every combination of 
coils from the shortest to the longest (both primary and sec- 
ondary) with every variation of E. M. F. may quickly be 
tested by this method. Irregularities of vibrator action which 
the most expert operator could not detect by ordinary obser- 
vation, are apparent to the ear through the telephone re- 
ceiver. 

3. Bipolar test. Connect the bipolar electrode to the ter- 
minals of the battery in the usual manner. For very fine 
tests with exceedingly mild E. M. F. let the tips of one finger 
rest lightly upon each metallic half of the electrode. With 
larger currents grasp the electrode closely in the palm of the 
hand. Any harshness, rasping, or irregular quality of the 
current will be made apparent to tactile sensation by the use 
of this method. 



I02 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

By means of any of these tests, the physician can compare 
correct action with imprpper action, and regulate the inter- 
rupter to its maximum of smoothness and rapidity. 

A Satisfactory Faradic Battery for Physicians' use.— 
More faradic batteries are in the hands of physicians and the 
laity than all other forms of electrical apparatus combined. 
This is due, in part, to the few cells required, to the supposed 
" harmlessness " of the faradic current, and to the earlier and 
erroneous teachings that about 80% of electro-therapeutic 
work could be done with this type of battery. 

An immense proportion of these batteries were never worth 
anything for medical uses. A large number of others are now 
as obsolete from age as a bicycle of ten years ago. Improved 
high tension induction coil (faradic) batteries are in the hands 
of very few men at the present date, and no physician who 
does not possess such an apparatus can write of faradic cur- 
rents or teach their uses from the standpoint of the one who 
does. 

Prominent authors have stated within a very few years that 
no satisfactory faradic battery was made. One writer has put 
on record his opinion that no satisfactory faradic battery ever 
will be made. As a matter of fact, a high efficiency and satis- 
factory, practical, and easily operated induction coil apparatus 
can now be bought by any physician for a sum but little 
greater than that paid for batteries of the kind which have 
been condemned by every competent expert in the uses of in- 
duction currents. 

A so-called cheap faradic battery is therefore a wasteful in- 
vestment, not economical even for the beginner, and injudi- 
cious for the practical physician. 

The finer therapeutic properties of coil currents are depend- 
ent upon superior mechanism, and non-medical batteries do 
not possess the essential mechanism. There is about the same 
difference in quality between the family battery and a scien- 
tific medical battery that there is between the cutting edge 
of an iron blade and a razor of tempered steel. When this 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 103 

fact is recognized by all physicians, the clinical results they 
obtain will be improved accordingly. 

A medium grade faradic battery, with one or two medium 




Fig. 17, represents the Author's High-Tension Induction Apparatus. This im- 
proved therapeutic apparatus embodies the following features : An upright 
switch-board with posterior invisible compound induction coil, approximating 
8,000 feet of 36, 32, and 21 wire coils, permanently fixed over the primary helix, 
the author's original secondary current controllers and primary rheostat ; the 
author's method of dose measurement, an interior battery of six dry cells; 
also rapid and slow interrupters, pole reverser, adjustable magnetic field 
switches, etc. A complete description of this apparatus, written by the author, 
was published in the Times and Register, August 25th, 1894; and an account of 
the method of dose measurement appeared in the New York Medical Record, 
December 21st, 1895. 

coils, a single and non-adjustable vibrator, and perhaps two 
cells, may be bought for $20 or $30, and with it some of the 
coarser external applications maybe made; but it is not neces' 



104 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

sary to purchase a cheap apparatus for crude work and a fine 
apparatus for fine work, for a single practical and well-con- 
structed induction coil apparatus will cover the whole range 
of faradic therapeutics from general faradization to vaginal 
and intra-uterine methods. No other type of faradic battery 
will then be required. 

In 1893, I began the experiments which resulted in the pro- 
duction of an extremely satisfactory and by no means costly 
induction coil apparatus, since made and sold by the J. Kidder 
Mfg. Co., 820 Broadway, New York City. (Fig. 17.) 

The upright switchboard of the author's apparatus presents 
a plain vertical surface to the operator without any visible 
faradic coil. It was designed by me with a view to placing in 
the specialist's hands, and in the hands of the educated general 
practitioner, an effective portable apparatus which would be 
entirely dissociated in the patient's mind from the frequently 
discredited ordinary coil batteries in common use. 

The switches are all exceedingly simple to operate, and may 
be managed with equal convenience by either the right or left 
hand. Six dry cells are fitted in the portable case, giving a 
great range of E. M. F., and any desired number of these cells 
may be switched into circuit on the switchboard. 

The coil and current controlling devices in this battery are 
unique and practical. Behind the switchboard is a high ten- 
sion compound Kidder coil, with the entire set of secondary 
coils fixed permanently over the primary coil, so that no slid- 
ing back and forth is required. These cdils combine nearly 
8,000 feet of wire of assorted sizes, making upwards of 15,000 
windings, tapped at approved lengths. By adjusting the switch 
arms connected with the coil the operator can produce twenty- 
one combinations in the secondary circuit, and can also unite 
the primary coil with any of the secondary coils. The sim- 
plicity of the arrangement is a decided advantage over a series 
of separate spools operated by the old-fashioned sledge or 
plunger methods. 
. The primary circuit rheostat controls the E. M. F. from the 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. I05 

cells. The secondary rheostat controls the current in circuit 
with the patient, entirely independent of the cells in use. 

This apparatus was not only the first to employ a secondary 
current controller independent of the primary, but is still the 
only battery provided with the author's rheostat. 

Regulation of Current Strength All methods of regulat- 
ing faradic dosage, except through a secondary current rheo- 
stat, are incomplete and unscientific. Plungers and sledge 




Fig. 18 Rheostat. 

arrangements not only add a detail to technique which de- 
mands the attention of the operator but the therapeutic qual- 
ities of any secondary coil are not fully developed until its 
entire length overlaps the primary. If a fixed number of cells 
is used and the strength of the current reduced by advancing 
the secondary coil, only part of its .length it is shorn of its 
best qualities and is improperly employed. 

If an excessive E. M. F. is cut down by a rheostat in the 



J06 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

cell circuit the vibrator is deprived of part of its actuating 
force, and may become irregular or stop. 

The problem of satisfactory control was solved by the author 
in the rheostat devised in the early part of 1894. 

This rheostat, which is the peculiar novelty introduced in 
my high-tension induction apparatus, consists of two glass 
tubes marked one and two. They contain compound fluids, 
one of high and the other of low resistance. The resistance of 
the first tube is practically 1,000,000 ohms, and is sufficient 
to control the full coil, high tension current, and reduce the 
perception of it to zero in the most delicate application to a 
patient. 

The second tube possesses a much lower resistance (55,000 
ohms) for currents of less potential and for gynecological uses. 
The fluid in either tube, selected at will by a switch, regulates 
the dosage by means of an adjustable rod regulated at differ- 
ent heights of the column. 

The resistance of each tube was measured in the physical 
laboratory of Columbia College, New York City, for the pur- 
pose of employing the scale of this standardized rheostat in 
making a record of clinical treatment. 

Not only has abundant experience confirmed the practical 
utility of this rheostat as first described by me in the " Medical 
Record" of December 21, 1895, but the following letter, written 
at the close of some three months of experimental work, 
leaves little more to say upon the subject : 

" New York, December 17, 1894. 
" Dr. S. H. Monell. — Dear Sir : I return herewith the two 
tubes containing liquid resistances which you submitted to 
me. I have calibrated each tube and provided it with a scale 
which shows its electrical resistance in ohms for every position 
of the movable electrode. My opinion in regard to these de- 
vices is as follows: i. A liquid resistance is a very simple 
and convenient means of obtaining very high resistance for 
medical use. 2. By changing the liquid the range of resist- 
ance may be varied from several megohms to a fraction of an 
ohm. 3. The screw adjustment of the electrode enables the 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. I07 

resistance to be gradually varied to any value, without the 
sudden shock which occurs when resistance coils are cut out. 
4. The resistance is non-inductive, hence there is no reaction 
against or distortion of the current, which is very important in 
connection with induction (faradic) coils. 5. A short circuit 
cannot occur, the electrodes being arranged so that it is impos- 
sible for them to come in contact, whereas there is serious 
danger of short circuit in resistance coils with high-tension 
currents. 6. The resistance is practically definite and con- 
stant, provided the temperature remains nearly the same. 
With the small currents ordinarily used the heating effect is 
small. 7. The effects of polarization and electrolysis are in- 
significant, since the potential is high and the current is alter- 
nating in the case of induction-coils, with which these resist- 
ances are to be used. 8. The liquid does not appear to be af- 
fected by the action, or to change in any way, but it is of 
course impossible without actual trial to tell what effect might 
occur in a long period of time. Any difficulty of this kind 
might be overcome by renewing the liquid occasionally. 
" Yours truly, 

" F. B. CROCKER, 
" Professor of Electrical Engineering, 
Columbia College." 

Slow Vibrator. — Every faradic apparatus for proper medi- 
cal work must of necessity contain an automatic slow inter- 
rupter which will permit a regulation of the rate from between 
sixty and one hundred periods per minute up to a couple of 
thousand. The major part of muscle-contracting applications 
call for a rate of about one hundred per minute, although no 
exact number or count of periods is required. Few of the 
common faradic batteries contain such a vibrator. Some con- 
tain a slow interrupter which is affected by variations in the 
primary E. M. F., and is therefore not capable of satisfac- 
tory adjustment except at the sacrifice of the action of the 

coil. 

In the apparatus designed by me this very important device 
is not only adjusted independently of the strength of current 
which reaches the patient but is thrown into action by the 
movement of a single switch. The change from the rapid to 
the slow vibrator can be made without any of the seven or 



I08 THE ESSENTIALS OF FARADlC ELECTRO-PHYSICS. 

eight changes required with separate coil batteries, and is 
instantaneously accomplished by one movement of the finger. 

The Rapid Vibrator. — One of the chief defects of common 
faradic batteries is the coarse and inadequate means of inter- 
rupting the current. The crude vibrator is neither fast nor 
slow, cannot be finely adjusted, and would destroy the thera- 
peutic qualities of the entire apparatus, even if the coil was of 
a superior make. 

Different types of rapid interrupters have been tested dur- 
ing past years. The question of a satisfactory interrupter 
cannot be settled when the clinical dosage is regulated solely 
in the primary circuit. The spring vibrator has come nearest 
to illustrating the survival of the fittest, but if the spring vi- 
brator is crudely made it acts very poorly; When it is finely 
made and the parts kept brightly polished and adjusted it is 
eminently satisfactory. By a simple mechanical suggestion, 
derived from my experience with the static machine, I have 
secured upon my own induction coil apparatus a rapid vibra- 
tor which possesses the following qualities : 

It can readily be kept bright and adjusted, and when this is 
done it starts into action the instant any one or more cells is 
switched into circuit. It requires none of the usual assistance 
in starting. 

It very rarely stops during treatment until the current is 
stopped by the operator. Its action is exceedingly fine, 
smooth, and constant. 

It holds its rate and smoothness without alteration during 
treatment, because the driving force in the primary circuit is 
wholly independent of the dose regulation in the secondary 
circuit. 

For the same reason it is not affected by the manipulation 
of electrodes, the regulation of the dose, or any accidental 
jarring of the floor or table on which it stands. For the same 
reason also it holds its adjustment during continuous action, 
and the entire battery does not demand five minutes' care per 
day to keep it in running order. 



THE ESSENTIALS OF FAKADIC ELECTRO-PHYSICS. IO9 

The slight sound made by the vibrator is so unobtrusive 
that it is scarcely perceptible to the patient, and never annoys 
the most delicate ear. 

Rates of Interruption. — Almost all variations in practical 
clinical work are sufficiently indicated by the terms rapid and 
slow. The term rapid throughout this book is applied only 
to the most rapid action obtainable with the best type of 
spring vibrator. It is immaterial in clinical practice whether 
this rate is exactly any number of thousand periods per 
minute. The number of vibrations represented by the musi- 
cal note C which at one time figured largely in electro-thera- 
peutic writings has no practical bearing on the subject. 

The medium rate of common vibrators on cheap batteries 
is not sufficiently rapid to produce the effects desired in seda- 
tive apphcations, and is far too fast for the muscle effects of 
slowly interrupted currents. Such a vibrator is therefore 
limited in range and almost useless. 

The so-called singing rheotome introduced several years 
ago was not satisfactory. 

To those who desire to demonstrate the differences in phys- 
iological effect of varying rates of interruption, the static 
machine affords an impromptu means of making tests. It is 
difficult, if not impossible, to construct a faradic device which 
can be adjusted at will to give every known rate of interrup- 
tion from, for instance, one to a million per minute, but to ac- 
complish this with the static is no trouble at all. It is only 
necessary to turn the machine slowly or rapidly and hold near 
the positive conductor a grounded ball electrode. Its range 
of action cannot be excelled, for I can shift it to any degree 
of proximity between actual contact and a full sparking limit, 
say six inches. We can thus demonstrate that an excess of 
rapidity in breaking the current will thwart the purpose for 
which breaks are made, and that a moderate interval is re- 
quired between the discharges to produce perceptible effects. 
As a handy object lesson, it is worth many pages of theory 
upon the subject. 



no THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

Care of the Author's Induction Coil Apparatus.— The bright 
parts of the switchboard, which require occasional cleaning' or 
polishing, are removable, as are also the tubes of the fluid 
rheostat. When, after some use, the platinum tips and in- 
terrupters become oxidized, they should be unscrewed and 
polished with a little sapolio on a small piece of moistened 
cloth, or with a jeweler's buff, but never scraped with a knife, 
as is commonly done. The more carefully the vibrators are 
kept bright and free from tarnish, the more satisfactorily they 
will work. Whenever a black spot forms under the platinum 
ball, clean it off, even if it has to be done every day, and the 
rheotome will then perform its duty faithfully. If the inter- 
rupter loses its spontaneity of action, look for oxidation and 
remove it by polishing both ball and spring. 

Operative Facility. — No feature of the author's improved 
type of faradic battery gives greater satisfaction to the phy- 
sician than the facility with which all changes in the current 
may be made without startling or annoying the patient. 

If it is desired to substitute a shorter and coarser coil (or 
any other secondary coil) for one of different length and size, 
or to switch additional cells into circuit, or to reverse the 
polarity, or in fact make almost any desired change in the 
technique or dose, it may be made at will without withdraw- 
ing any spool or searching for another coil, or stopping the 
battery to begin again from zero ; and should the vibrator 
occasionally stop during treatment it can be set going again 
without startling the patient. 

In batteries depending upon the sledge coil or primary 
rheostat for regulation of current strength all sudden fluctua- 
tions must be carefully avoided. They are liable to cause the 
patient a greater or less degree of shock, and unless due cau- 
tion is observed in treatment the patient acquires a nervous 
dread of having the battery " meddled with " during an appli- 
cation. This destroys her comfort and impairs the benefit. 

These objections are obviated in my apparatus by the action 
of the useful secondary rheostat. This takes up the excess 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. Ill 

force of sudden fluctuations and protects the patient. If the 
change is one which decreases the dose it will cause no sensa- 
tion whatever. If it increases the dose only the normal in- 
crease will be felt and no startling surprise to the patient 
will accompany the change. It can be made entirely imper- 
ceptible by first raising the secondary rheostat a trifle. 

Among other practical features of the switchboard are 
switches to reverse the positive and negative pole at will dur- 
ing treatment, and to select for use either one of three grad- 
uated current controllers, and any desired amount of E. M. F. 
from one up to six cells. The priniary rheostat may be 
partly or wholly switched out of circuit as may be desired, 
and the secondary rheostats can also be cut out of circuit and 
the entire regulation be made through the primary. 

Both the rapid and slow interrupters are operated by a 
single magnetic field which is adjustable to any relation with 
either rapid or slow vibrator. 

The absence of separate coils to shift, exchange, or slide on 
runners relieves the operator of detail and removes a prolific 
source of nervous dread to the patient. By means of a com- 
pound switch the physician instantly selects the size and 
length of coil desired. The portable dry cells can be removed 
from the case and new ones inserted by the physician without 
sending to the factory. Terminal posts upon the switchboard 
may be connected with outside fluid cells if the operator 
prefers to use them in his office work. 

The apparatus is inclosed in a handsome mahogany case 
and is easily portable about an ofirce, although somewhat heavy 
to carry a distance. Without, however, lessening its effective 
appearance it may be lightened for outside practice by stating 
the requirements to the makers. It is constructed for all- 
round work, but may be adapted to special practice by omit- 
ting any part of the series of coils or cells which are not needed 
for limited applications. 

Quality of faradic currents from the author's improved 
high tension induction coil apparatus.— No part of the lit. 



112 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

erature of electro-therapeutics is now so unreliable for the 
guidance of the general practitioner as that pertaining to what 
are called faradic currents. Teachings upon this subject by 
those who employed the commoner forms of faradic batter- 
ies which were practically the only ones available ten years 
ago, and are still in too common use, are obsolete for the in- 
struction of the practitioner to-day. 

Statements made by leading and original observers (even 
including Tripier and Apostoli and some of the best teachers 
in the field in this country) are also misleading, for they are 
based upon clinical work with apparatus quite inferior to the 
best now obtainable. I do not recall more than two or three 
authoritative writers who have enjoyed the advantage of speak- 
ing from practical experience with high efficiency induction 
coil apparatus. I have never seen a text-book on general 
medicine or nervous diseases which did not refer simply to 
inferior faradic batteries which we no longer use. 

In references to pain said to be caused by faradic currents, 
and the action of such currents upon pelvic inflammatory pro- 
cesses, almost all the outstanding literature is either more or 
less misleading or decidedly obsolete. 

On the other hand the physician may turn from the crude 
and jerky current with which his imperfect battery has made 
him familiar and read of so-called sinusoidal machines which 
produce " painless currents and remarkable effects." He may 
read that the sensations produced by the appHcation of this 
instrument differ radically from those which result from the 
employment, of an -ordinary faradic coil. " They are much 
softer and more agreeable. They produce painless muscular 
contractions, abolish pain in painful diseases, stimulate the 
nerves of special sense, and actively promote the metabolic 
processes." 

It is entirely correct to say that these effects are beyond the 
capabilities of the family battery, but they are entirely within 
the ordinary capabilities of improved induction coil apparatus 
such as I have employed for the past three years. It is only 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. II 3 

because the reader associates " faradic " currents with inferior 
faradic batteries that he is attracted by the apparent superiority 
of a strange and unfamiliar device. The author's improved 
induction coil apparatus produces a greater variety of currents, 
and is not only portable and less expensive, but is simpler in 
operation and therapeutically more efficient. The past state- 
ments of writers have been chiefly made without taking into 
account the superior type of faradic battery, and it will be 
observed that comparisons of the two currents, the alternating 
and the faradic, are always made with reference to the kind of 
faradic batteries not employed in fine therapeutic work. 

Not only does my apparatus produce the " even and smooth 
sensation," described above, the " muscular contractions of 
great vigorwithout pain," the " luminous effects upon the optic 
nerve," but also with the positive electrode upon the back of 
the neck and the negative upon the abdomen it will stimulate 
the gustatory nerve and produce the well known metallic taste 
so familiarly associated with galvanic action. 

Recording the Dose of Faradic Currents.— The secondary 
circuit fluid rheostats of the author's apparatus constitute a 
practical basis for approximating and recording the therapeutic 
dose of the induction currents employed. 

A faradic meter or measuring instrument similar to the 
familiar galvanic meter has never been made, and owing to the 
qualities imparted to coil currents by variations in voltage, 
amperage, and rates of interruption the idea of such an instru- 
ment pertains only to the realm of theory. It is not practi- 
cable. 

No actual meter is required by the operator in regulating 
the current strength to produce desired effects, but all who 
trace the work of investigators through the literature of the 
past fifty years must admit that the words faradism a^nd fara- 
disation tell the doctor nothing about the dose or method of 
application. No one who studies existing text-books for aid 
to the treatment of a patient can fail to wish that there was a 
standard method of reporting the essential facts relating to 



114 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

treatment so that others could employ the same method and 
procure equally good results. 

Quite a good deal has been written about the dose measure- 
ment of faradic currents, and, for the purpose of establishing 
correctly the exact nature of the measuring problem in the 
reader's mind, I shall cite the following extract from my article 
on this subject published in the Medical Record, Dec. 2i, 1895 ; 

and Medical Times and Register, Aug. 25, 1894 : 

A group of contemporary statements upon the subject of 
faradic dosage will be recognized by all familiar with the 
literature of electro-therapeutics. 

1. " A bar to the progress of faradism is the impossibility 
of satisfactory therapeutic measurement. Edelmann's faradi- 
meter is incomplete and, I must even add, misleading as a 
physiological or therapeutic measure.'' 

2. " The Edelmann faradimeter, which is not by any means, 
as was intended, a measure of- faradic electricity, is too com- 
plicated and expensive for the practitioner, ... and is 
merely a deceptive snare for physiological or therapeutic pur- 
poses. The strength of the current zuould be far better approxi- 
mated by indicating the nature of the coil and the resistance 
offered than by the volt scale of this faradimeter." 

3. " Unfortunately we have no means of measuring accu- 
rately the dose of faradism, the only means at our command 
being the millimetre scale placed at the side of the coils. 
This is a very rude method, indeed, but it is all we have at 
present." 

4. " It is much to be regretted that we have no means of 
accurately measuring the therapeutic dosage of the faradic 
current." 

5. " The old attempt to measure the faradic dose by a coil 
movable over a primary core, on a graduated scale, was so un- 
scientific and inadequate as to be ridiculous." 

6. " It is the ability to record the doses of the current to 
which must be ascribed the rapid progress of galvanism. To 
give the necessary impetus to faradism, we must obtain this 
same precision, . . . and toward this end my efforts have 
been directed ever since I realized how seriously this valuable 
remedy was affected by its vagueness and uncertainty ; and as 
early as 1886 I sought to approximate dosage by a defining 
and precising of details." 

7. " The precise measurement of the faradic current for 
therapeutic purposes has not as yet been satisfactorily attained. 
The method heretofore in vogue, of measuring on a scale the 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 11$ 

distance the secondary coil is advanced over the primary, is- 
inaccurate and delusive — in fact, means nothing — since the 
battery current varies with use ; and no estimate is taken of 
the variable resistance encountered in the external circuit, 
which is altered by the location of the electrodes, by their 
size, and by the distance between them. The fact that this 
current possesses the same two qualities as the galvanic current 
— pressure and volume — makes it evident that we must in 
some manner estimate the relative voltage and amperage of 
the current employed in order to arrive at a practical con- 
clusion of its comparative value." 

The striking remark which closes the .second comment cited 
above, although not observed by the writer previous to the 
preparation of this article, foreshadows what is substantially 
accomplished by the method to be described in this paper, 
and which was originated by me, January 29, 1894. My 
method also takes into account what is suggested as necessary 
in comment number seven, but before proceeding with de- 
scriptive details, certain relative facts require to be understood. 
These are as follows : No automatic meter or measuring in- 
strument is required to select the proper dose of faradism for 
a patient, or to adjust it to the needs of therapeutic use. 
Direct currents need such an indicator, but induced currents 
do not. The educated skill of the operator regulates the dose, 
and does it adequately. The existing need is for a standard 
system of recording the treatment administered, and thus 
impart uniform value to the reports of clinical cases, and in- 
troduce precision and definiteness into the special literature of 
the subject. My method does this. 

The accepted dose measurer of the constant current is the 
milliamperemeter, adopted universally within half a decade, 
and which in general estimation has lifted the galvanic current 
from empiricism and placed its therapeutics on a scientific 
basis. Let us, therefore, note exactly what the milliampere- 
meter accomplishes and what part it plays in the dose record, 
in order that we may better understand the problem before us 
in attempting to measure and record the dose of induction 
currents. 

To enable separate observers to compare and repeat results 
in clinical cases treated by galvanic current, we should take 
into account every factor which affects the action of the cur- 
rent. A comprehensive record must necessarily inform us 
then, on the following points: i. Surface area or types of 
electrodes — which range from needles, sounds, tips, etc., to 
small or large pads, or water-baths, or may be clay, copper, 
zinc, carbon, platinum, steel, tin, brass ; or covered with 



Il6 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

sponge, cotton, felt, etc., determining conducting power and 
density of the current. 2. Situation of both positive and 
negative electrodes during treatment. • 3. Tissues treated and 
their pathological state, symptomatic conditions, etc. 4. 
Time and frequency of administration. 5. Reading of the 
milliamperemeter, or current volume. 

Clinical reports of these particulars, with results of treat- 
ment, would be complete ; and while of the various factors the 
meter furnishes but one, it supplies the last essential to the 
dosage of galvanism. 

When we enter upon the problem of faradic dosage, we find 
the factors no fewer, but differing in character. These are 
now: I. Character of the current, as determined by the coil 
employed. 2. Description of electrodes and their situation 
during treatment. 3. Rate of current interruption. 4. Tis- 
sues treated, condition, etc. 5. Current strength. 6. Time 
and frequency of application. 

The missing link in our clinical record is a means to state 
the current strength. We can sufficiently indicate the rest. 
How shall we measure the current .strength ? Now, certain 
features enter into the measurement of a constant current 
which are eliminated from the case of an interrupted or alter- 
nating current. The therapeutic requirements of the two are 
inherently dissimilar. The galvanic current is silent in its 
flow and physiological activity. Without observing the de- 
flection of the meter needle, or making other test, we may be 
in doubt whether or not the battery is in action until the cur- 
rent is strong enough to be felt by the patient, and as a guide 
to treatment the patient's sensations are incompetent. The 
predominating quality of the direct current is volume — its 
voltage being relatively small in medical uses — and " volume " 
cannot be determined by the eye or ear of the operator. On 
the other hand, the induction apparatus, through its break- 
piece, which is the essential, the very life of this form of 
electricity, gives forth to the ear and sight unmistakable evi- 
dence of action ; and its current is one of predominating force, 
of insignificant volume, chiefly mechanical in its physiological 
effects, and nearly devoid of chemical properties. It therefore 
requires no peculiar safeguard, like the milliamperemeter, 
against an excess of electrolytic or cautery action within the 
tissues. Moreover, owing to the feeble power of dissociation 
possessed by the constant current, an enormous range of un- 
certainty enters into every galvanic application without a 
meter in the circuit; for the actual current strength — i. e., 
dose — from the same number of cells and with the same 
electrodes will vary greatly with the degree of resistance of 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. II 7 

the skin, etc., so that similar conditions of E. M. F. are no 
guide whatever to similar doses and effects. With the gal- 
vanic current, with either 5, 10, 20 or 40 cells E. M. F., and 
with the electrodes in a glass of water, I can cause the meter 
to vary from 2 to 250 milliamperes, without altering the elec- 
trodes or the battery, simply by lessening the resistance of the 
water. 

The nature of the induction current, however, is such that 
little of this great variability occurs in clinical applications 
when similar conditions of treatment are repeated. A given 
E. M. F. will produce a definite current strength from a given 
induction coil, and repeat it under the same conditions as 
often as desired. The influence of slightly varying skin 
resistances of different parts of the surface of the body is in- 
significant in the case of the higher voltage and penetrating 
capacity of currents from induction-coil apparatus. We have, 
in fact, but two practical conditions of resistance to consider 
in faradic therapeutics, viz., the greater general resistance of 
the skin in external treatment, and the lesser resistance of the 
moist, mucous surfaces of the cavities of the body. Thus 
presented, we observe that the problem of faradic dose- 
measurement, or means of record, is much simpler than was 
that of the now solved problem of galvanic dose-measurement ; 
for if we can by any means indicate the electrical or mechani- 
cal energy of our induced currents under conditions identical 
with their clinical administration we are assured of obtaining 
the same energy for therapeutic uses and repeating it upon 
patient after patient with substantial accuracy. A standard 
indicator of current strength will accordingly serve as a subse- 
quent dose register for future applications from all similar ap- 
paratus, and although not a meter may serve as a substitute 
for purposes of record. 

The methods so far suggested for measuring the dose of in- 
duction-coil currents are as follows : 

1. A strip of suitable material, wood, celluloid, or vulcan- 
ite, is placed at the side of the coil and marked in fractions of 
inches, or of the decimal scale. The current increases in 
strength as the coil overlaps the primary, and the dosage is 
taken to be the extent of overlap during the stance. The 
capabilities of measurement are exhausted when the overlap is 
complete, and the record must be alike for one or four cells, or 
No. 36 or No. 16 wire coils. It is not surprising that this at- 
tempt to measure current strength by a foot-rule was never 
scientifically successful. 

2. The graphic method of marking the current waves; a 
purely fanciful idea adapted for blackboard illustration of cer- 



Il8 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

tain currents characterized by sufficient amperage to operate 
the tracing-pencil, but neither practicable outside of the ex- 
pert's hands, nor capable of demonstration at all with the cur- 
rents of higher tension and frequency, and consequently 
smaller amperage now performing so much of the therapeutic 
work of improved induction apparatus. 

3. The Edelmann faradimeter. The name faradimeter is 
felicitous and suggestive of a proper method, but it has never 
reached a more practical stage of development for ordinary 
use than have ships for navigating the air. It is a compli- 
cated, expensive, though highly scientific, meter for the 
voltage of the current in the short circuit ; and since ther- 
apeutic applications involve the interposition of body tissues 
this instrument has no relation whatever to a physiological 
unit. 

4. Micro-coulombs were asserted to be the electrical unit 
by which to express faradic measurement, but when we turn 
to the coulombmeter for aid we are practically where the 
faradimeter left us. There is no need of any coulombmeter. 

5. Voltmeters, ammeters, and wattmeters that fill success- 
fully their proper places in measurements of large commercial 
currents, do not supply us with any means to meter the small 
currents of medical coils. If a miniature wattmeter could be 
made to work it would be too expensive for general use. 

6. Rate of interruption. It is assumed that if this is stated 
in mathematical terms a certain amount of precision will be 
secured. Other factors, however, affect the question of dosage 
too materially to place dependence solely upon knowing the 
frequency of the periods. 

This brings us to consideration of the substitute method 
proposed by me. The method was first made possible when I 
introduced my fluid current controllers into the secondary 
circuit. They easily supersede in value all previous methods 
of regulating current strength. 

The switchboard of my induction apparatus presents a rapid 
interrupter (vibrations of 20,000 to 30,000 per minute) ; a slow 
vibrator capable of adjustment from about two thousand pe- 
riods per minute down to less than one period per second ; a 
cell selector throwing into circuit from one to six cells at will ; 
an eight-button compound coil selector ; a pole reverser and a 
metallic rheostat governing the primary current. This con- 
sists of a perpendicular column seven inches in height, wound 
with German-silver wire of definite resistance, making twenty 
turns to each inch of column. Attached to it is a registration 
scale to denote every wind of wire from zero to 140, and per- 
mit a record of position in every degree of use. This scale is 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. II9 

also an advance in accuracy of record, first suggested by me. 
But the peculiar novelty introduced in this apparatus is the 
author's secondary circuit rheostat, which consists of the glass 
tubes seen at the left of the switchboards and marked respect- 
ively I and 2. They contain prepared fluids of great resist- 
ance (much greater than water), and are the first competent 
controllers successfully applied to the secondary current of a 
medical induction battery. The capacity of the first (one meg- 
ohm) is sufficient to control the full coil, high-tension current, 
and reduce the perception of it to zero in the most delicate 
external applications to a patient. 

The second tube possesses a much lower resistance, for cur- 
rents of less penetrative force. Each tube is scaled in ohms 
of their actual resistance, measured and calibrated for me by 
Professor F. B. Crocker, of Columbia College, New York. 
The rationale of my method is now extremely simple. The 
fluids in one or both tubes, and at certain heights of the mova- 
ble contact rod, varying with the primary E. M. F. and cur- 
rent density, entirely nullify the patient's perception of the 
activity of the induced currents, /. e., control them, and reduce 
their physiological and therapeutic manifestation to zero, and 
afterward regulate them to any strength we desire. What 
resistance to the energy of any given current does it require to 
do this? The answer to this question approximates the dosage 
in standardized apparatus. 

The scale referring to tube No. i shows the total resistance 
of its four and a half inches of fluid column to be one megohm. 
As the movable electrode descends in the tube the resistance 
lessens until it is only 900, 800, 600, 400, 200 thousand ohms, 
and soon down to the minimum, when the electrodes of the 
. rheostat are nearest contact. The great resistance of this 
tube is designed to regulate the higher tension currents of the 
compound coil, which, in this apparatus, I have caused to be 
placed invisibly behind the switchboard, and fixed in complete 
overlap upon the primary helix. This coil is immovable, and 
does away with former sledge methods of sliding coils on and 
off, while it generates at all times the maximum of inductive 
influence. 

Tube No. 2 is of much lower resistance, ranging from 55,000 
ohms down to a residual resistance of 4,000 ohms, and is suited 
to the regulation of currents of small voltage, from short, 
coarse coils, or other applications where great tolerance exists, 
as within the pelvis. Ati additional turn of a switch also cuts 
out these secondary rheostats, and furnishes all currents direct 
from the coils, in case this is desired. The metallic rheostat 



I20 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

in the primary circuit then regulates the strength by altering 
the E. M. F. 

In applying a given current strength to a patient, the energy 
at first wholly expended within the secondary rheostat, when 
perception of the current is nullified on its passage through 
the rheostat to the patient, is released from the controlling 
rheostat to exert itself within the tissues when the descent of 
the movable rod in the tube reduces resistance proportionate 
to its descent. In other words, as the restraint of the current 
falls in the rheostat, its released energy rises in the patient, 
and by measuring the degree of restraint we find the equiva- 
lent of the released energy in the circuit. 

" Things which are equal to the same thing are equal to 
each other," and knowing the graduated resistance in electrical 
units of ohms interposed and removed from the secondary cir- 
cuit at will, our knowledge of Ohm's law substantially defines 
for us the values of therapeutic dosage. We have only to let 
a portion of the measured rheostat substitute itself for the pa- 
tient's tissues while we at first regulate the degree of energy 
to employ, and next to record the same current value in re- 
sistance, to arrive at a very practical measure of the dose ad- 
ministered. The resistance of the body is compensated in the 
process, and causes no error, and the battery E. M. F. is unal- 
tered during the dose regulation. 

While, therefore, the once proposed scale of fractions of inches 
was a purely fictitious and ridiculous travesty upon scientific 
dose-measurement, the author's method is a comparative record 
of the current strength, and not a mere fragment of a tailor's 
yardstick. As such a resistance register and rheostat is of 
general applicability, and may be placed by all instrument- 
makers upon high-grade batteries if properly standardized for 
clinical use, it may be fairly claimed that the general adoption 
of my method would supply the long-expressed need for pre- 
cision in faradic dose records until the invention of a meter. 

To illustrate the method let us hold, for example, two ordi- 
nary electrodes in the hands, select for our coil one thousand 
five hundred yards of No. 36 wire, and employ very slow in- 
terruptions of, say, seventy per minute. We raise the rod in 
tube I to its full height, and switch four cells into circuit. 
Gradually lowering the contact rod, we note the point where 
the current becomes first perceptible to sensation. It is at 
700,000 ohms resistance on the scale. Taking this as our zero 
unit, we continue to lower the rod until muscular contractions 
are produced as strong as we desire. The rheostat now indi- 
cates but 100,000 ohms, showing that 600,000 ohms of resist- 
ance have been removed from the passage of the current into 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 121 

our arm muscles, which respond to the force previously ex- 
pended within the rheostat. If now I record the facts: Coil, 
1,500 yards of No. 36 wire. Interruptions, 70. E. M. F., four 
cells. R. 600,000 ohms, small sponge electrodes in hands, 
positive in right ; I can repeat the exact application and mus- 
cular effect whenever and as often as wished, even should the 
cells deteriorate by use so as to require five or six cells to 
equal the energy recorded. There is no parallel to this pre- 
cision of record to be found in the literature of faradic elec- 
tricity. The method allows for all possible variations in treat- 
ment. 

Again using a short, coarse coil, one hundred and fifty-four 
yards No. 21 wire, for instance, we obtain sensation with a 
given contact at 36,000 ohms resistance of tube 2 ; and full 
tolerance is reached when but 4,000 ohms remain. The given 
dose is therefore the electrical energy represented in removing 
32,000 ohms of resistance, with the current quantity value in- 
dicated by the capacity of the wire in the induction-coil. It 
is not essential to know the amperage with a corresponding 
voltage, for we are not dealing with galvanic, but with induced 
currents, in which volume is subordinate to potential and 
kinetic energy ; and our different coils — long, medium, short, 
fine and coarse — take on a definite individual identity under 
habitual use, which serves the expert as a practical expression 
of their ampere values. Our second record reads with elec- 
trodes same as before, but a more rapid rate; coil, 154 yards 
No. 21 ; frequency, 300; cells, two; R., 32,000 ohms. 

In making a vaginal bipolar application with a very rapidly 
interrupted high-tension sedative current we use tube 2, with 
its low resistance, owing to the enormous tolerance of the 
tissues treated. 

An illustrative clinical record reads as follows: Vag. bipolar 
sedation, coil, 1500, No. 36. Rapid vibrator, E. M. F. 4 cells. 
R 45,000 ohms, twenty minutes, daily. 

If this seems to express a small dose (an inadequate estimate 
of the great tolerance of the pelvic tissues), it must be remem- 
bered that it is the difference between zero sensation and the 
maximum current strength administered with electrodes applied 
in actual treatment, which is recorded as the dose, and not the 
difference between the sensitive nerve-filaments of the hand 
and tissues whose dullness of sensation and low resistance to 
current diffusion permits them to accept with comfort and 
benefit an application which would be painful on the surface of 
the skin. If the dose was reckoned from a zero obtained in 
one arbitrary manner, .say, by touching the electrodes with the 
finger or thumb before applying them to the patient, it would 



122 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

bear no genuine relation to the dosage of larger contact areas, 
of different varieties of electrodes and different parts of tfie 
body. 

To be a scientific and universal method it must answer for 
all conditions of treatment, and my method does this perfectly. 
The use of a single cell, or of any number up to six (the battery 
contains six cells), will determine the zero at a higher and lower 
point on the scale, and the same cells, as they deteriorate, in 
time will alter their E. M. F. ; but these variations do not alter 
the accuracy of my dose record, which is the difference between 
the minimum and maximum rheostat readings independent of 
the number of cells it takes to furnish the given inductive 
force. 

The difference, also, in power to penetrate tissue resistance 
will create a different zero point for each length and size of 
wire, even with the same E. M. F. inducing force and same 
electrodes ; but with standard coils, a standard method of find- 
ing the actual zero point in all cases, with any coil, with any 
number of the battery cells at any period of their life, my 
method furnishes a flexible, permanent, and accurate measure- 
ment of the true therapeutic dose. Its adaptability to varying 
conditions of current volume, voltage, resistance, and density 
removes all sources of error. 

This method, carried out in its fullest detail, is particularly 
applicable to the records of clinicians and other observers whose 
investigations require an exact comparison of results. In 
general practice the physician will soon familiarize himself, at 
least approximately, with the position of the rheostat for 
various zero readings, just as the skilled book-keeper soon 
remembers the ledger pages of his accounts ; so that actual 
tests for zero will be unnecessary except, perhaps, in the first 
treatment of a new case. If the full dose record is considered 
superfluous for the physician's own records in his ordinary office 
work, a modification will furnish satisfactory notes for personal 
reference. In using the modified method which I suggest, we 
need not repeatedly calculate the actual dose administered, 
but dimply note the conditions under which the maximum 
current was applied by recording the lowest reading of the 
scale. For example : coil, looo. No. 36. Rapid V. : cells 5 ; 
scale 6000 ; tube 2 ; vag. bipolar, 20 minutes. There is no ex- 
pert electro-therapeutist equipped with similar apparatus, who, 
on reading this record, could not instantly apply the same 
treatment with substantially the same dose, though he were a 
thousand miles away. The use of initials for full words will, 
of course, abbreviate the record in private case-books and be 
equally intelligible to understanding. 



THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 1 23 

Of the other factors requiring report for purposes of uni- 
formity in cHnical observations, the character of the electrodes 
can always be identified by sizes, numbers, or names, as in 
makers' catalogues. Quantity and quality, the elements of 
induced currents subordinate to their energy and pressure force, 
are, as we have seen, suiificiently expressed by reference to the 
particular coil employed. A more exact description will hard- 
ly be required by experts in electro-therapy. As the trained 
electrician becomes accustomed to the quantitative and quali- 
tative differences in effect between every coil in his apparatus, 
whether 500, 1,000, or 1,500 yards of No. 36 wire, or 800 or 500 
yards of No. 32 wire, down to shorter coils of No. 21 or 18 size, 
he accurately knows the characteristics of currents from them 
all, and utilizes their diverse properties with intelligence and 
precision. 

It would add no therapeutic value to his knowledge if the 
current volume, per coil, was noted by a meter in terms of 
amperage, or the E. M. F. in volts. 

There now remains but one factor of dosage still surrounded 
by vagueness and lack of precision in theory, although clearly 
enough defined for practical purposes. This relates to the 
record of the rate of current interruption, a very important 
part of the matter indeed. Very low rates (50 to 300) can, 
however be stated in comparative figures, while very rapid 
interruption does not require a numerical term to express its 
frequency. Speed, as stated in mere figures per minute, is so 
involved with other qualities of adjustment, evenness, con- 
stancy, length of period, amperage, etc., that the advantage of 
a mathematical record can be greatly overestimated. 

I have referred to this in other of my writings, and, it is out of 
place to dwell on this point at present, though it is one of 
peculiar interest. A closely related feature, however, may 
claim our attention briefly. 

It is the ideal of some who have sought to define faradic 
dosage by rate of interruption, and who have devoted much 
time and special thought to the improvement of faradic 
apparatus, to construct an independent interrupter, actuated 
by a current separate from that which supplies the inducing 
force. 

The reason for this lies in the fact that every change in the 
regulation of current strength made in the primary circuit 
varies the rate and force of the interrupter in instruments as 
generally made. A prominent writer has ably argued the 
advantages of such method, and states that it can be adapted 
to every kind of contact-breaker, the motor power for the 
rheotome being furnished by a single separate cell. The im- 



124 THE ESSENTIALS OF FARADIC ELECTRO-PHYSICS. 

portance of steadfast E. M. F. and unvarying evenness of 
interruption througliout all gradations of tlie induced current 
strength, is so great, so essential to the satisfactory employ- 
ment of faradic electricity, that no battery not providing for 
independent secondary current control can be considered as 
representing the advanced progress of to-day. 

Manufacturers of medical batteries, however, do not all agree 
with the writer who advocates the separate cell for the in- 
terrupter, and are well-nigh unanimous in declaring that the 
mechanical obstacles to the device are insurmountable in prac- 
tice. The theory is correct, but makers have failed to apply it 
successfully to the vibrators in common use. My apparatus 
easily surmounts the difficulty ; furnishing not alone one cell 
to actuate the break-piece, but places six at our disposal at 
will, as independently as any theorist could desire. My former 
article describing the improved induction apparatus designed 
by me, referred to this feature at some length, but I wish to 
emphasize again the far-reaching importance of the secondary 
rheostats which accomplish this purpose in my battery, and to 
state further that, were their usefulness and influence restricted 
to mere regulation of induced current strength, without jarring 
or irregularity, or change in the primary flow, the advantage 
they would thus contribute to clinical handling of both patient 
and battery would alone stamp the apparatus as without an 
equal in therapeutic convenience and capabilities. That beyond 
this these rheostats make possible a practical dose record, is 
proof of their fundamental necessity to a perfect instrument. 
If still unconvinced that they are indispensable, let us attempt 
to adjust a slowly interrupted induced current — say fifty periods 
per minute — to a dosage of strength sufficient to produce 
powerful but painless, rhythmical, and non-tiring contractions 
of certain arm muscles, with a gradual and even decrease to 
scarcely perceptible sensation. With the ordinary interrupter, 
sliding coil, or primary rheostat, it cannot be done without 
altering the E. M. F. or affecting the vibrator rate, even with 
the costliest appliance in the market. With my apparatus it 
is done instantly and with the most striking success. As an 
object-lesson in the inadequacy of old methods of current regu- 
lation, and of the superior efficiency of my secondary rheostats, 
it leaves nothing open for argument. 

Our next step will be the study of how we can utilize faradic 
currents in producing therapeutic effects. 



CHAPTER VIII. 

PHYSIOLOGICAL AND THERAPEUTIC ACTIONS OF INDUC- 
TION COIL CURRENTS WITH RAPID AND SLOW 
INTERRUPTIONS. 

Effects of different rates of interruption. Effects of rapidly interrupted high 
tension currents. Effects within the pelvis. Effects of different coils. 

The influences of faradic currents upon living tissues are 
those which result from different degrees of electro-mechani- 
cal energy combined with but a minimum of dynamic, chemi- 
cal, or electrolytic action. Induction coil currents are allied 
to mechanical forces by their higher voltage, while their small 
amperage and intermitting activity deprives them of dynamic 
influences which depend upon a larger volume of continuous 
current flow. 

Faradic currents may first be judged by considering sepa- 
rately the difTerent effects of slow and rapid interruptions 
rather than of fine or coarse coils. It is true that the conduc- 
tivity of copper wires increases with their diameter capacity, 
and a number 32 or 21 wire coil will carry greater amperage 
than a No. 36 wire coil ; but E. M. F., potential and rate of 
" make and break " are factors which actively dominate the 
fractional amperage of coil currents. 

When a slowly interrupted faradic current excites a motor 
nerve it causes a series of slow muscular contractions. When 
the interruptions are sufficiently rapid, and the current 
strength is adequate, a state of continuous tetanus is produced 
in the muscles through which the current passes. 

Contractions will be most powerfully manifested at the 
negative electrode, in all variations of E. M. F., when both 
electrodes are of equal size and material ; and the negative 

I2S 



126 ACTIONS OF INDUCTION COIL CURRENTS. 

pole is therefore said to be more stimulating than the positive. 
If the positive electrode is small and the negative large the 
positive will be the most "stimulating." 

If the interruptions of any coil current are very slow — from 
fifty to one hundred per minute — the muscles have time to 
contract and relax with an interval of rest, so that very vigor- 
ous effects can be produced with neither pain nor fatigue. If 
the rapidity of the stimuli is increased to two or three hun- 
dred per minute, without in any way altering other factors of 
current strength, the muscles will not have time to relax and 
rest, and fatigue and distress will result and finally become 
intolerable. The dose must be immediately reduced or the 
muscles will be overworked and exhausted. 

With a slowly interrupted current of moderate strength— a 
strength which can be regulated with mathematical precision 
to suit all cases, as will be explained elsewhere — we wish to 
exercise muscles beneficially and promote their function, nu- 
trition, activity, endurance, and strength, which various causes 
may diminish. 

The physiological effects of improving muscle function by 
slow, forcible, faradic contractions are so well understood by 
all physicians that they require no further comment. To ob- 
tain these benefits we usually employ a rate between seventy 
and one hundred and twenty-five periods per minute. With 
an improved high tension coil a positive electrode may be 
placed, for instance, upon the cervical spine and a negative 
electrode applied to the muscles of the forearm and the E. M. 
F. regulated from zero to maximum so as to cause any de- 
sired degree of contractions between the merest perceptible 
impulse beneath the negative electrode and vigorous yet 
agreeable exercise of the entire limb. In all therapeutic work 
requiring muscle stimulation of this character an exact regula- 
tion of the dose must accord with the effect sought. 

If the interruptions are now carried to an extreme rapidity 
of many thousand per minute (20,000 to 30,000), a strong cur- 
rent will set up a tetanic contraction, and a current strength 



ACTIONS OF INDUCTION COIL CURRENTS. 1 27 

beyond tolerance applied in tiiis way will soon tire the letan- 
ized muscles; but by moderating the dosage and also the 
method of applying the same coil current with the same rate 
of interruption a great variety of effects can be produced. 
Muscles can be restfully exercised, the circulation and nutri- 
tion of parts improved, congestion and pain allayed, and 
fatigue and pain caused by previous improper application of 
too strong a current can be speedily removed. 

The physiological effects of induced currents are therefore 
not the inherent properties of certain long, medium, or short, 
fine or coarse coils, but are the product of method, dosage, 
and manipulation, of E. M. F., amperage, circuit resistance, 
rate of interruption, and special electrodes. An understanding 
of this practical fact will straighten out much of the prevailing 
confusion about choice of coils and different lengths of wire. 

Slowly interrupted faradic currents act but little upon non- 
striated muscles. Rapidly interrupted induction currents, 
however, contract involuntary muscular fibre, set up intestinal 
peristalsis and produce other effects not possible with only a 
slow vibrator in circuit. 

The more rapid rates afforded by an adjustment of the slow 
vibrator (from two hundred up to two thousand per minute) 
may be employed as vigorous electrical massage and to break 
down adhesions, but are not suited to functional contractions 
of groups of muscles, or for sedation. 

If employed in- vaginal faradization to stimulate muscle 
fibre the application should be short, as more than a few mo- 
ments' use of such a current over-stimulates muscles and pro- 
duces exhaustion if a strong, stimulating dosage is employed. 
Short sittings with this character of current are also useful 
within the pelvis to break up adhesions and exudates and dis- 
perse venous engorgement after inflammation and tenderness 
have been removed by sedative currents. 

The most remarkable effects of faradic currents are obtained 
when the make and break follow each other with intense 
rapidity and in a perfectly smooth and even manner. The 



128 ACTIONS OF INDUCTION COIL CURRENTS. 

quality of the rapid interrupter is, tiierefore, more than any 
other single part of the apparatus, the key to current quality, 
character, and effects. 

The therapeutic work accomplished by induction coil cur- 
rents upon and within living tissues is inseparably associated 
with the contraction of muscle fibre. Control and manage- 
ment of these contractions in different degrees produce widely 
different effects. They unite upon nutrition the good effects 
of exercise, warmth, increased blood supply, and massage. 
They are a circulatory, muscular and nerve stimulant, tonic 
or sedative, according to the manipulation and dose. They 
contract blood vessels as well as muscles, quicken the circula- 
tion, combat blood stasis and promote the absorption of re- 
cent effusions and effete products. 

The ordinary faradic battery in common use is so incompe- 
tent a therapeutic instrument that few physicians are prepared 
to appreciate the importance of improved coil currents in 
other realms of physiology beyond the gross muscular con- 
traction that any interrupted current will cause. The effects 
upon metabolism, upon functional and nutritional processes 
of what are now called high tension currents from improved 
and scientifically constructed apparatus are of a remarkable 
nature. They command interest and demonstrate result, 
which no drug medicinal agent can produce. By their gen- 
eral application the processes of oxidation are quickened, the 
elimination of urea, carbonic acid, and water is increased, and 
incomplete food combination is carried forward to more com- 
plete combustion, assimilation, and nutrition. 

More and more with each step of advancing knowledge the 
general effects of electricity in palliation or curing many dis- 
eases are accounted for by its influence upon nutrition. "It 
aids nature to restore the sound state." The action of an 
electric current starts a process which continues long after the 
current stops. 

Rapidly interrupted, high-tension induction currents set up 
within the tissues what may be considered as fine, vibratory, 



ACTIONS OF INDUCTION COIL CURRENTS. . I2g 

molecular or protoplasmic massage instead of gross muscular 
contraction. When these vibratory impulses are directed with 
the blood current they re-inforce the vermicular movement 
of arteries and the functional activity of nerves. Vibratory 
impulses in the opposite direction diminish both nerve and 
arterial currents, just as counter-vibrations act elsewhere 
throughout mechanical-physics. A rapidly intermitting, 
moderate current in the direction of the blood flow increases 
the blood current, and in the opposite direction retards or 
lessens it, hence, it is the usual rule to act upon this idea in 
placing electrodes and selecting polarity in applications which 
require that these effects be taken into account. The induc- 
tion coil current with its marked polarity possesses this 
advantage over the alternating current which is constantly 
reversed and has no polar difference. 

With electrodes applied upon the surface of the body the 
effects of rapidly interrupted high tension induction coil cur- 
rents depend upon the current strength (E. M. F.) and man- 
ner of application, 

With a mild E. M. F. the effect is superficial and chiefly 
vasomotor and sensory. With a gradual increase of E. M. F. 
with stabile electrodes, the current gradually grasps the sub- 
jacent muscles in proportion as penetration increases with 
voltage, and finally maintains a physiological tetanus. 

This tonic contraction is sooner developed if one electrode 
rests upon a motor point. If one electrode is whipped over 
the various motor points of a part, or if it is lifted from the 
surface and the muscles are simply touched by it at regular 
intervals, there results peculiar contractions of the affected 
group of muscles which are of a different character from those 
produced by the transient impulse of a slow-vibritor current. 
They contain the tonic, vaso-constrictor effects of the high 
frequency current and produce a muscular exercise which is 
unique in kind. A fatigued arm thus exercised with practiced 
skill is rapidly refreshed instead of being made more tired, 
and quickly t^lres on a feeling of lightness and buoyancy. 



130 ACTIONS OF INDUCTION COIL CURRENTS. 

An opposite effect is produced if the electrode is steadily 
held upon the motor point. The irritability of the nerve is 
then reduced, and, if a sufficiently strong E. M. F. is persist- 
ently maintained the muscle may be tired out. Tonic spasm 
is sometimes thus relieved by exhausting the over-excitability. 
What would be a sedative,-or even anodyne action of a given 
current may be merged into a sedative-tonic or even stimu- 
lating effect by simply changing the operative technique. 

We have thus seen that a variety of actions upon living 
tissues can be demonstrated by high efficiency faradic cur- 
rents considered as a whole. They increase secretion, will 
cause perspiration of the hand holding a bare metal electrode ; 
will promote synovial lubrication in dry and creaking joints ; 
they stimulate nerves of special sense, will cause flashes of 
light before the eyes, and a metallic taste ; they increase met- 
abolism and act as a sedative tonic, nutritional stimulus ; they 
effect nerve sedation and circulatory tranquilizatiori, allay pain, 
promote absorption through the capillary and lymphatic cir- 
culation, combat blood stasis, relieve congestion, and will both 
reduce acute local inflammation, or hasten suppuration if this 
is inevitable. It is currents of this character which have rev- 
olutionized the uses of faradic electricity and rendered the 
common battery obsolete. 

The pelvic effects of high tension induction coil currents 
call for special remark. They are as interesting and valuable 
as any within the scope of electro-therapeutics and no physi- 
cian in either general or special practice who has women for 
his patients can, at the present day, afford to remain unin- 
formed on this subject. 

Upon the skin, supplied as it is with sensitive nerves and 
offering some resistance to the current, the polar actions are 
localized near the electrodes or the current passes between 
them without much lateral diffusion. In the soft, moist cav- 
ity of the pelvis, however, the conditions are radically differ- 
ent and are singularly fitted to wide diffusion of the current, 
and to painless tolerance and utilization of doses that are far 



ACTIONS OF INDUCTION COIL CURRENTS. 131 

beyond the pain-bearing-limits of the sensitive skin. The 
mucous tissues are well-nigh as good a conductor of these cur- 
rents as a salt solution ; they are circumscribed by a periph- 
ery which is a bad conductor, and within the cavity the dif- 
fusion of the current by the bipolar method reaches every 
tissues and immediate ramification of nerves and vessels. 

This high conductivity, low resistance, and compact relation 
of the pelvic organs creates possibilities for the bipolar method 
of faradization that do not exist' elsewhere in the human 
body. 




Fig. 19. • 'Jt, . 

Correct form of bipolar vaginal electrode employed with high tension coil cur- 
rents in gynecological uses. 

The credit of the happy and manifold effects of this method 
in peri-uterine diseases is due as much to these favorable con- 
ditions as to the properties of the current. The full effects 
of vaginal bipolar faradization are difificult to state in words 
for they are dependent on the state of the patient and the 
lofal pathology, as well as upon a score of variations in dosage 
and management of the current which may be imparted by 
operative technique. 

Within the pelvis the first marked effect is the relief of ten- 
derness and pain if these exist. The application can be made 
either sedative, anti-spasmodic and anti-congestive, or tonic, 
stimulating, and muscle-contracting. If stimulating, it 
quickens the capillary circulation, contracts the small arteries, 
augments the blood pressure and disperses nervous engorge- 
ment. The powerful current stimulates the contraction of all 
intra-pelvic muscular fibres and the absorptive processes of 
the lymphatics, relieves local congestion, and accomplishes 
rapid absorption of recent infiltrations and exudates. " It is 
the most powerful, certain, and therapeutically valuable vaso- 
motor constrictor we possess." 



132 ACTIONS OF INDUCTION COIL CURRENTS. 

The sedative action of these currents applied so as to pro. 
duce local sensory anaesthesia and recuperative rest is incom- 
parable with any other medicinal agent. For the relief of 
pelvic pain and congestion, and pelvic inflammations and their 
results, infiltrations and exudations, vaginal bipolar faradiza- 
tion acts not only as a remedy for the symptoms but with 
distinctly curative effects. As an auxiliary to other measures 
beyond its direct capabilities it performs a service of extraor- 
dinary value in many cases. It serves an exceedingly useful 
purpose preparatory to surgical operations by its tonic action 
upon the local tissues and by improving general nutrition. 
The disappointment so frequently the lot of patients who have 
submitted to an operation only to find their pains unrelieved 
may be often removed by subsequent applications of some 
form of electricity. 

Sedation to the mind and an increase of general nutrition 
are among the promptly noticeable effects of vaginal bipolar 
faradization. The entire nervous system is soothed, sleep is 
improved, appetite and digestion, renal elimination and other 
functions are benefited. 

One of the perplexities of the student of electro-therapeutics 
who has been accustomed only to the single coil battery relates 
to the uses of so many different coils as are part of scientific 
apparatus. Let us note what actually happens when different 
coils are practically tested by the clinician. The facts are 
easily demonstrated with a high tension induction apparatus 
containing a secondary circuit rheostat. 

If the resistance is proportioned to the different degrees of 
voltage so as to diffuse or limit the action of each coil through 
about the same area of tissue — and this can be done — it is 
demonstrated that each and every coil in an entire set of 
twenty-one combinations can be adjusted to produce very 
similar mild and medium effects, although the maximum cur- 
rents of different coils exhibit very different degrees of local- 
ized current strength. 

The tissue-penetrating power of any current depends upon 



ACTIONS OF INDUCTION COIL CURRENTS. 1 33 

its E. M. F. versus circuit resistance. If resistance remains 
the same a high voltage impulse will diffuse into the tissues 
further than an impulse of lower voltage, and hence will appear 
to be milder, or, as is commonly stated, more " sedative." 
Conversely, the low voltage impulse will be less diffused, act 
upon a less area of tissue, and this concentration of the dose 
upon a reduced number of muscular fibres makes it appear to 
be stronger or more "stimulating." 

When this is understood we see that the purpose of a variety 
of coils is to enable us to obtain all needed doses to procure 
given effects in different cases, rather than to supply a great 
number of different effects by multiplying the number of coils. 

It is generally stated that the primary coil relieves pain, 
that the short, coarse, secondary coil is for muscular contrac- 
tions, that medium coils are for the same use when parts are 
too sensitive to endure coarser, and that the long, fine, second- 
ary coil is for sedative effects. Sometimes it is stated that the 
coarse coil causes painful contractions and the long coil does 
not, while others have reversed this statement and set forth 
various and complicated views. 

The effect of any coil current will vary with alterations in 
the inducing force, the rate of interruption, the character of 
the interruption, and the resistance of the circuit. I have re- 
peatedly adjusted the resistance so that trained physicians 
with their eyes shut could not guess whether the current they 
were experimentally testing to corroborate these assertions 
came from the shortest and coarsest, or longest and finest coil 
in the series. A coil of 154 yards of No. 21 wire and a coil of 
8,000 feet of fine wire can be made to produce moderate cur- 
rents so alike to sensation that the most expert electro-thera- 
peutist cannot tell them apart. 

These remarks of course do not apply to the unregulated 
effects of coils of different calibre, length, and number of 
windings. In ordinary practice coils have usually been tested 
with a fixed inducing current and without the necessary rheo- 
stat in the secondary circuit. In this case there is no regula- 



134 ACTIONS OF INDUCTION COIL CURRENTS. 

tion of resistance, and the gross maximum currents of different 
voltage and amperage from different coils appear to affect 
tissues differently because they are not really acting upon the 
same tissues but are either concentrated or diffused according 
to voltage. 

A variety of coils is required by the differing clinical condi- 
tions under which dosage is regulated. Knowing the effect 
we seek to produce we can pass from one coil to another, if 
the first falls short of the mark. With a complete high 
efficiency apparatus with a means of regulating the resistance 
in the secondary circuit, the question of which coil to select 
for a given case becomes simply one of a moment's test to ar- 
rive at the requisite current strength with any coil that will 
produce it without hampering ourselves with theoretical con- 
siderations. 

Every physician who can adjust a vibrator, regulate the cur- 
rent strength and apply electrodes correctly, can procure 
these effects at will, and has at command a remedy of incal- 
culable clinical value. From the study of the two preceding 
chapters to the successful treatment of patients, is but a short 
step. 

'•l'' »i{' K ■ Si' -' W'i ■■ ■" ' 



WWW u'^'unv 



CHAPTER IX. 

THERAPEUTIC EFFECTS OF « HIGH FREQUENCY " 
CURRENTS. 

The physiological effects of currents of high potential and 
high frequency upon protoplasmic metabolism have been 
pretty thoroughly investigated and determined during, the 
past five years. They are summarized by Apostoli as 
follows: 

Clinical tests upon more than a hundred .patients, show that 
these currents exert in the majority of cases a most powerful 
and generally beneficial action upon diseases due to slackening 
of the nutrition, by accelerating organic changes and combus- 
tion. This is proved by analysis of the urine made by Dr. 
Berlioz, of which the following is a brief r^sum^ : ./" '' . 

The quantity becomes more normal ; the products of or- 
ganic waste are better eliminated. The increase of combud- 
tion is shown by the diminution of uric acid, while the per- 
centage of urea is generally increased. The relative propor- 
tion of these two substances changes under treatment, so as 
to reach in general the figure of V40. The elimination of 
the mineral products is also changed, but in a manner less 
marked. 

When daily s/ances a.re given, each lasting fifteen minutes, 
we may generally observe in patients submitted to the in- 
fluence of these currents the following modifications in their 
general condition. We mention them in the order of their 
occurrence. 

Return of sleep. 

Increase of strength and vital energy. 

135 



136 EFFECTS OF "HIGH FREQUENCY" CURREN-TS. 

Increase of gayety, of power for work, and ability to walk. 

Improvement of appetite, digestion, etc. 

In short general progressive improvement. 

This general improvement often manifests itself after the 
first stance before any local influence is apparent, and before 
any change has occurred in the urinary secretions. 

Local pain and trophic changes are often more slowly 
affected by these currents, and are at times, entirely refractory 
for a longer or shorter period, and in such cases, the same 
currents must be applied locally by contact with the elec- 
trodes, for general electrization by any form of current must 
be localized at the seat of local pain. 

The diseases which have appeared to derive most benefit 
from this therapeutic agent belong to the arthritic class ; 
rheumatism, gout and diabetes. 

In conclusion, the currents of high frequency and of high 
tension introduced into electro-therapeutics greatly increase 
the field of action of medical electricity. They furnish gen- 
eral medicine with a new and valuable means of treatment 
capable of modifying more or less profoundly the processes of 
nutrition through the vasomotor system and exerting a 
powerful action upon all living bodies subjected to inductive 
influence. 

Although the above remarks were written with reference to 
the currents from peculiar apparatus, they apply equally to 
currents from static machines which furnish high potential, 
and high frequency currents for medical use, in their most 
practical forms. 

Note. — A complete and up-to-date section on High Frequency currents and 
their practical uses (written five years after this chapter was first published) will be 
found in the author's new work entitled, "A Pictorial System of Instruction in 
X-Ray Methods and Medical Uses of Light, Hot-Air, Vibration and High Fre- 
quency Currents." The same work teaches all methods of employing X-rays in 
both therapeutics and diagnosis. Published in 1902, it is an immense advance on 
the author's X-ray writings of 1897 in "Manual of Static Electricity." 



CHAPTER X. 

THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 
Care of the apparatus. Dose regulation. Standard current tests. 

The Essentials of Static Electro-Physics The static 

machine is purchased complete from the manufacturer, and to 
describe its construction and mechanical parts is superfluous. 
The few essential directions obtained from the maker at the 
time of purchase inform the buyer about the mechanism and 
all that remains to learn is familiarity with clinical methods. 
. The range of usage to which this great machine may be put, 
from the simplest electrification of a patient to the production 
of the most powerful X rays, separates it widely from any 
other type of electrical apparatus in either the industrial or 
medical field. 

Prior to Roentgen's remarkable discovery the static machine 
remained caviare to the general. - Those who were never near 
enough to a fine machine to touch it, or who viewed it 
through the spectacles of others who unsuccessfully employed 
an inferior and ill-kept apparatus, were indifferent to its splen- 
did capabilities ; but any physician who will take a little 
trouble to practice the proper treatment of patients with this 
apparatus can demonstrate in his own office that it is the most 
efficient and valuable single appliance in therapeutics. 

It is now not only a satisfactory but an indispensable part 
of the electro-medical equipment of both the specialist and 
the general practitioner. It has become a necessity also to 
the surgeon, and having become acquainted with its usefulness 
through the enlightening influence of X rays he will find it of 
great practical value in the post-operative treatment of a great 

137 



138 THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 

variety of cases. The clinical results procurable by the aid of 
the static machine are largely dependent upon the skill of the 
operator. It has been imagined in some quarters by those un- 
familiar with the subject that less skill is required in the em- 
ployment of static electricity than in the use of galvanic and 
f^radic currents. This error explains why those who hold 
this view and carry it into practice are disappointed in their 
clinical results. It is useless to attempt the employment of 
the static machine as an automatic cure-all. 

The galvanic current requires proper care and attention to 
detail in its administration, yet when the electrodes are in con- 
tact, the circuit closed and the dose adjusted, the electrolytic 
and therapeutic action goes on independently of the operator. 

This is not the case in static therapeutics. During every 
instant of treatment the effects procured depend, upon tech- 
nique, management of the patient, machine, and electrodes,^ 
and not upon the intrinsic properties of static currents. The 
small therapeutic value of static electricity in the hands' of a 
novice and the great value of the same agent when the ad- 
ministration is properly conducted exhibit a disparity which is 
almost beyond belief. 

To produce the best results each form of medical current 
must be administered with proper skill, and in this respect 
they are all alike. Any physician who obtains a proper course 
of clinical instruction in the management of the static appa- 
ratus and will devote a short time daily for a few weeks to im- 
proving his skill by practice, can accomplish both the best 
quality of X ray work and therapeutic results of great value 
by the aid of the static apparatus. 

In this chapter I shall consider only essential points of clini- 
cal usefulness. 

It is an important starting-point in the perfect working of 
the static machine that it should be properly set up in the 
physician's office. It should stand evenly and firmly upon 
the floor so that when in rapid motion it will neither jar nor 
shake. 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 1 39 

If it is run by a motor, the belt should be joined by a small 
steel hook embedded into the leather and make no click when 
it meets the wheel. The plates, combs, collectors, and all the 
internal parts should be correctly adjusted so that none grate 
or rub upon each other. Without an accurate adjustment 
of the machine it cannot be expected to operate satisfac- 
torily. 

The revolving glass plates should turn evenly and smoothly, 
and when everything is in proper order the machine should be 
nearly noiseless when in action. In many respects the care 
required by a static machine resembles the care usually be- 
stowed upon a choice piano. 

It should be placed in a large and dry room. An inner 
room, or one in which the sun freely enters, is to be preferred. 
It should be covered when not in use, and should be daily 
dusted, and its metallic parts kept bright with a rouged 
chamois. The electrodes should be similarly treated. 

There exists an active affinity between all parts of a static 
machine and the floating particles of dust in the atmosphere 
of a I'oom, and for this reason it should be protected from dust 
as much as possible. 

Attention to these details will maintain the beautiful ap- 
pearance of the machine and keep it from looking tarnished 
and neglected. The entire case, metal parts, platform, rod, 
and chains should be kept scrupulously clean. 

When the machine is first purchased the external brass 
parts and electrodes will be found coated with shellac which is 
a bad conductor. It must be dissolved with alcohol and en- 
tirely removed from the sliding poles, rod, and metal parts of 
all the electrodes. 

At the very commencement the interior of the case must be 
thoroughly dry and ever after kept so. The method of keep- 
ing the interior dry deserves special attention, for the success- 
ful employment of the machine depends much upon the ab- 
sence of- internal moisture. 

During the seasons of the year when the atmosphere of the 



I40 THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 

house or office is artificially dried by furnace or other heat 
there will of course be no additional necessity to dry the in- 
terior of the machine, but in summer when no fire is used and 
when the doors and windows are frequently open, every misty 
or rainy day will saturate the air of the house with moisture. 
This is the period of discontent for the static machine, but its 
evils are moderated by judicious care. Various expedients 
have been suggested to dry the internal plates, but one and 
all methods heretofore mentioned for this purpose should be 
discarded for the following plan, which is now universally 
adopted as the best. 

Obtain two or four fire-proof dishes or bowls of common 
white crockery, not too large to enter the case, but sufficient 
to hold together ten pounds of chloride of calcium. It is fur- 
nished in hermetically sealed containers of ten pounds each. 
It is usually taken from the can and put directly into the 
machine by uninstructed operators, but this should never be 
done, for it is exceedingly hygroscopic and always contains 
more or less water when purchased. Unless this is first 
evaporated and the chloride thoroughly dried it will liquefy 
more rapidly and be far less effective in the case. 

Accordingly divide the contents of the can between the 
dishes and bake them in a moderate oven until the calcium is 
white as chalk. It may take but an hour or two, or an entire 
day, depending on the quantity of moisture to dry out and 
the relative heat of the oven, but bake it till it is thoroughly 
dry no matter how long it takes. 

The heat should not be sufficient to boil the water (if part 
of the chloride is in a liquid state), or it will run over the edge 
of the dish and not only waste but necessitate cleaning the 
oven. Never let any liquefied chloride of calcium spill on a 
carpet or the floor of the office, for it is a disagreeable sub- 
stance. 

When an examination shows the baking to be thoroughly 
done remove the dishes from the oven to a suitable pan, cover 
them with a dry towel, carry them to the machine, and trans- 



THE ESSENTIALS OF STATIC ELECTRO-PHYSlCS. I4I 

fer them quickly to its interior. Instantly screw fast the 
doors. The machine will then be ready to operate. 

The chloride of calcium may be rebaked as often as neces- 
sary, and by using dishes that can be put in the oven without 
injury the same material can be utilized again and again with 
very little waste. I use the same chloride for at least a year 
before throwing it away and, procuring a fresh can. In the 
winter time it remains dry and is practically not needed within 
the machine, but I leave it there because it is the safest place 
to store it where it can he found. In the spring and fall sea- 
sons I take it out about once a month and in the Worst of dog- 
days about once a week, but the actual state of the chloride is 
the indication for baking it again and not the lapse of any 
particular time. 

The next and more important matter to attend to after a 
new machine is set up in running order in the office is to pro- 
vide metallic groundings for both poles, and for the several 
electrodes. 

Uninstructed operators often drop a chain from the sliding 
rod to the floor, but the clinical results of such physicians are 
not always gratifying. When a current of electricity is con- 
ducted to earth it should be by a metallic route, and a high 
potential difference between the static poles depends upon 
good conduction, as well as upon the capacity and power of 
the machine. Static electricity has no fixed voltage. The 
operator controls it by his management of the apparatus. 

Two separate groundings are essential. Without them the 
machine loses fifty per cent, of its efficiency. If the office 
contains gas and water pipes both, they serve the purpose. If 
not, the physician can drive two pieces of iron pipe into the 
ground deep enough to reach moisture, and connect these with 
convenient situations in his ofifice by heavy copper wires. As 
there are few offices which do not contain running water and 
gas I shall proceed to describe how to employ them as ground- 
ings. 

Procure a necessary quantity of stout copper wire. Tack a 




Fig. 20. 



Grounding to the Water Pipe. AAAA is a stout copper wire passing under 
the frame of the machine, through the wall, to the most convenient water pipe, B. 
This may be either in the same room or in another room. Any water pipe which 
can be reached with a wire from the machine will answer the purpose. C repre- 
sents the chain dropped from the prime conductor to the floor and hooked over the 
wire A . D shows the hook in the wall upon which the chain is hung when not in use. 



143 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 143 

piece of it under the table of tlie machine and carry it along 
the baseboard of the room to the water pipe, to which the end 
of the wire should be permanently fastened. This is utilized 
for grounding one of the poles of the machine, by Hnking one 
end of a brass chain to it, and hooking the other end of the 
chain upon the sliding pole which is not connected with the 
platform during treatment. To remove the grounding after 
treatment simply unhook the chain from the sliding pole and 
hang it on a convenient peg in the wall, or drop it on the 
floor. 

The gas fixture grounding requires no preparation if a chan- 
delier from the ceiling is in convenient relation to the platform 
and is brass. If it is bronzed iron or some composition which 
is a poor conductor a piece of stout copper wire should be bent 
into a hook at the lower end and carried up the chandelier and 
twisted around the gas pipe at the top. If the chandelier is 
not conveniently situated, or does not exist at all, a copper 
wire can be run from a side bracket to some point where a 
hook at the end will be most handy for the operator. 

The grounding of the electrode is accomplished by attaching 
the swivel of another brass chain furnished with the machine 
to the ring upon the metallic part of the electrode and hook- 
ing the opposite end of the chain upon the chandelier or wire 
connected with it. 

No operator who has not provided metallic conduction to 
earth can create a high-potential difference between the oppo- 
site polarities, and therefore cannot equal the best therapeutic 
work of which his machine is capable. 

After providing conduction for the indifferent pole and the 
electrode, the next step is to provide good and direct conduc- 
tion from the active pole to the patient. Poor conduction in 
this respect is a fruitful source of failure. If the platform 
surface wastes half or two-thirds of the current before it gets 
from the end of the rod to the patient it must be furnished 
with a better conductor, for extravagance in current waste is 
fatal to therapeutics. New platforms are sometimes varnished. 







Fig. 21. 

The above diagram illustrates the author's use of the chandelier as a ground- 
ing for either machine or electrodes as desired. Stout copper wires AAAAA 
are carried from hooks in three convenient situations upon side walls near the 
static machine to wires BB which stretch from the top of opposite doors to the 
central rod of the gas fixture which conducts the current to the earth. I either 
attach the chain of my electrode handler to the lower portion of the chandelier or 
to any one of these hooks, whichever is convenient for the situation in which I 
stand to treat a given case. 



144 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. I45 

shellaced, or oiled, and shellac, varnish, and oil are all bad con- 
ductors. 

An oak platform with natural wood surface is probably the 
best for static use, and this can be dampened a little from time 
to time and its conducting efficiency increased. Metal, how- 
ever, is by far the best, although in some forms of application 
it possesses drawbacks which require experience to overcome. 
By far the most efficient way to get a current directly into the 
patient is through a metal tray placed under the feet, or a 
chain or rod held in the hands. I habitually use a brass tray 
about fifteen inches square, to one corner of which is attached 
two feet of chain. When the rod from the prime conductor is 
placed upon the platform in the usual way the free end of this 
chain is thrown around it and direct conduction is secured. 

As every screw about machinery in active vibration will tend 
to work loose, it is necessary from time to time to tighten the 
screws that close the doors and secure together the framework 
of the static apparatus. 

Every joint about the machine must be constantly kept as 
firmly tightened as possible. Some of the internal screws will 
occasionally work loose and permit two plates to rub together, 
or a comb to scratch and grate upon one of the revolving 
plates. When this happens it calls the operator's attention to 
it by the noise it makes and the trouble should be corrected 
by removing a door, setting the comb or movable plate back 
into proper position, tightening the screw, and closing the 
door again. The case, however, should be opened only when 
absolutely necessaiy, and a dry day selected for this purpose, 
for it at once lets the air of the room into the machine and 
temporarily lowers its working capacity. 

Very few parts of the improved Holtz machine require oil- 
ing. One of my former machines, with an axle bearing, re- 
quired regular oiHng through an external oil orifice at each 
end of the axle, but this method allowed some air con- 
tinually to enter the case and involved an extra amount of 
friction. My present apparatus contains ball bearings en- 
10 



146 THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 

closed in a permanent oil bath, with no openings to let in the 
air, and with the friction reduced to a minimum. These 
bearings constitute a great improvement in the apparatus and 
were introduced by the manufacturers at the author's request. 
As a veteran bicycle rider my familiarity with the advantages 
of ball bearings induced me to repeatedly urge their merits 
upon the makers of the Holtz machine. 

Charging this machine simply involves the principle of join- 
ing by metal conductors both poles of a frictional machine 
which will develop electricity by friction in all atmospheres, 
to the two poles of an induction machine which will develop 
nothing until the germ of the current is supplied, setting both 
sets of plates into action, and continuing until the induction 
plates take up the minor frictional discharge and magnify it 
into a high-potential current. 

The process may be instantaneous on a dry day, or may re- 
quire a dozen seconds under ordinary circumstances. A good 
deal depends on the dryness of the chloride within the large 
machine, and on the deficiency of the small frictional apparatus. 
On a damp summer day I have seen a small charger that was 
out of order consume half an hour in charging the induction 
plates. A charger that will give only a quarter of. an inch 
spark between its two poles will be very apt to do this. The 
charger within my present apparatus is constructed in a much 
better manner, with larger plates and better workmanship, and 
will give a one-inch spark. Its action is successful, convenient, 
and satisfactory. 

The static machine occasionally reverses its polarity. To 
prevent this occurrence Holtz introduced his ingenious diagonal 
conductor, a device which does not fully remove the fault, 
though it greatly increases the stability of the electrical charge. 
When this occurrence takes place in practice it is only neces- 
sary to become aware of it, aud connect the platform with the 
desired pole for therapeutic effects, provided that no inconven- 
ience to the operator results from the reversal. 

Sometimes, however, owing to the -situation of available 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. I47 

space and the relation of office accessories, it maybe a practical 
necessity to have the positive pole always at a particular end 
of the machine, where the physician becomes accustomed to 
its use with the most satisfactory convenience. This being 
my own case a few years ago, a reversal of polarity operated 
as a decided hindrance, and I therefore investigated the condi- 
tions which appeared to influence the shifting charge, with the 
result that I discovered a method of correcting the reversal, and 
described the same in the Medical Record, February 24th, 
1894. 

Thoroughly discharge the machine, and subject the plates to 
a sharp jar in some manner that is consistent with safety to the 
apparatus. With a six-plate twenty-six-inch machine the sim- 
plest method of doing this is to lift the positive end of the case 
a very short distance from the floor and drop it, using the pre- 
caution to avoid any damaging violence. An eight-plate thirty- 
inch machine is rather heavy to lift. 

Other methods are : Strike a few sharp taps with a hammer 
on the outer end of the brass cross rod supporting the upper 
set of diagonal combs, jar the case by blows upon its floor or 
side, etc. With care no damage whatever will be done the 
machine. 

To demonstrate success, recharge the plates, and if the posi- 
tive has not yet shifted as desired, try it again. On a good 
day for static the charge is sometimes more tenacious, and the 
object is not so readily accomplished. It then simplifies the 
matter to open both doors and discharge the machine more 
thoroughly. 

To discharge the Holtz machine when desired, revolve the 
plates backward until no spark will pass between the sliding 
poles when they are brought gradually together until they 
touch. Then touch each prime conductor with a grounded 
electrode and start the machine into action in the usual way. 
If the machine is discharged it will now produce no current. 
If the attempt to discharge it has not perfectly succeeded try 
it again. I kept a record during one year showing that my 



148 THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 

machine reversed thirteen times, and each time I corrected the 
change by the method above described. It sometimes took 
me only a moment, and once or twice it required half an hour 
to restore the desired polar relations. In my present ofifice I 
have abundant room, and need make no attempt to correct 
reversals. 

When the machine is not in action the poles should always 
be left some distance apart. If they are short-circuited by 
being placed in contact after the machine is stopped, it tends 
to cause a discharge, and require recharging the next time a 
patient is treated, although the state of the weather will affect 
this somewhat. 

Operation of the Static Machine in Summer. — I have often 
been spoken to by physicians about the trouble they experi- 
ence in getting an adequate current into the patient during 
rainy seasons in July and August. In some cases their machine 
gives a good discharge between the sliding poles, but little or 
nothing reaches the patient. 

It is difficult to say at a distance what may be the cause of 
the trouble in any given case. Non-experts sometimes think 
their machines are in perfect order when they are actually the 
reverse." They may also regard the conditions of the room 
favorably when the trained operator of static apparatus would 
at once detect a weak point. 

If the machine and room are dry and in good order the 
work done in July and August should rarely disappoint. In 
my own case I have entire confidence that my machine will 
work on every day in the year, for if it fails for a moment I 
speedily correct the trouble. The mastery of the conditions 
which enables me to do this can be acquired by other physi- 
cians without a doubt. I have never failed to quickly discover 
the cause of defective action in the case of machines in other 
offices when I have been able to make a personal examination, 
even though previous correspondence failed utterly to suggest 
the trouble. . 

It should be remembered, however, that few owners of static 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. I49 

machines have been carefully instructed in their management. 
They have usually bought an apparatus and picked up hap- 
hazard their slender stock of knowledge about it. The ma- 
chine is far too valuable to be viewed in an indifferent manner, 
and it will well repay the time and cost to procure the best in- 
struction possible. 

Motor. — -The consideration of motor power in connection 
with the static apparatus is quite important. Physicians in 
different localities have different methods available. Some will 
find it necessary to employ water as the power. Some have 
put in small gas engines. Some engage a boy to turn the 
machine. But wherever an electric street current is available 
an electric motor is the most satisfactory method. 

A primary battery for power is out of the question, and sec- 
ondary cells would be inconvenient, expensive to operate, and 
are also practically out of the question at the present time. 
When an alternating current runs through the physician's 
street there is, I am informed, some difficulty in obtaining a 
small motor that it will operate with satisfaction. The direct 
I lo-volt current is available in many places, and, as my per- 
sonal experience is limited to this current, I will describe only 
what I employ myself. 

I have a one-sixth horse-power Crocker-Wheeler motor. A 
one-eighth or even one-twelfth horse-power will run a static 
machine in perfect order, in perhaps half of its work, but as 
time goes by, and the plates may sometimes rub against each 
other and greater resistance may develop from other causes, 
it is wise to have some power to spare, and for this reason a 
one-sixth horse-power motor is always preferable. 

I employ but a single belt, running directly from the cen- 
tral shaft to the motor. My machine has no fly-wheel, but 
the Wimshurst charger is operated by hand with superior con- 
venience whenever it is needed. The use of the fly-wheel to 
operate both the charger and the larger plates involves some 
minor drawbacks. The additional friction is something, but 
the wobbling appearance of the revolving wheel, which is 



I50 THE ESSENTIAI,S OF STATIC ELECTRO-PHYSICS. 

almost always in the eye of the patient and the physician, 
becomes very unpleasant to any one who is accustomed to an 
invisible mechanism. 

I regulate the speed of the motor by a rheostat which was 
made especially for me. It has a resistance of 125 ohms, 
divided into 25 steps, so that the switch gives very even grada- 
tions of speed from the maximum down to a complete stand- 
still. 

When the machine is not in action the current should not 
be left passing through the fields of the motor, but should be 
switched entirely out of circuit in the way that an electric 
light is cut out. I have such a switch attached to the wall 
near my machine so that when not in use no current enters 
either the rheostat, the motor, or the flexible cords, and all 
danger of heating is eliminated from the portion of the circuit 
which is inside the office. 

A new motor will almost always give a little trouble until it 
gets settled to working order. It must receive sufficient, but 
very simple, care. The oil cups will need filling once in about 
two or three weeks. Whenever the commutator becomes 
blackened it should be made to revolve while a piece of 00 
sandpaper is held against it to remove the carbon. If too 
much oil is put in the bearings it will at times work up on the 
commutator and must be wiped off with a clean rag. 

It is of the first importance to have the brushes in proper 
relation to each other, and to the centre of commutation, in a 
given motor. These centres differ in different types, and or- 
dinary electrical workmen who simply wire houses for bells 
and lights are almost always ignorant about the adjustment of 
a motor, and will leave the brushes in a position that will en- 
courage heat effects and possibly sometimes ruin the motor 
coils. I speak of this because of a personal experience with 
the ability of workmen to botch a job they do not understand. 

If, when the motor is put in position, the wheel revolves the 
wrong way, it can be reversed by simply transferring the two 
short wires which connect its opposite poles. 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 151 

Whenever the belt stretches it should be promptly tight- 
ened so that it will not slip on the small wheel. 

Those who may order a rheostat for the control of a one- 
sixth horse-power motor would do well to specify a resistance 
of 175 ohms instead of 125, and the higher resistance will give 
control over the speed when the machine is short-circuited and 
running without resistance. I employ a bank of lamps for 
this purpose, but when the apparatus is all purchased at once 
the rheostat can easily include all the resistance that may be 
needed. 

The dosage of static currents in" general electrification with 
either pole is affected by the following: 

1. Rkte of revolution of plates from very slow to very fast, 
the activity of current output being in proportion to their 
speed. 

2. Good or bad conduction of the current from the ma- 
chine to the patient, and the insulating capacity of the plat- 
form. 

3. Attraction of the current away from the patient during 
electrification. 

4. Reinforcement of direct current by Leyden-jar con- 
densers. 

5. General atmospheric and physical conditions of the ma- 
chine and the office. 

6. Operative skill of the physician. 

The means at our command to modify, increase, or decrease 
the strength of treatment, and regulate its force to suit the 
varying requirements of disease, are complete and adequate 
in the case of static electricity without employing either a 
meter or a rheostat, such as are necessary with galvanic cur- 
rents. No such instruments are made for use with the plat- 
form applications of static electricity and we would not need 
them if they were. 

With the patient in position for treatment the poorest me- 
thod of connecting the pole of the machine with the patient 
consists in resting the lower extremity of the brass rod upon 



152 THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 

the corner of the platform surface most distant from the per- 
son's feet. 

A great deal of resistance must be overcome before the cur- 
rent reaches the patient, and the great difference of potential 
between the prime conductor and the patient, when both 
should be alike, is detected by requesting him to touch the 
rod with the hand and note that a spark will pass. It is obvi- 
ous that by this manner of placing the rod the patient will 
receive a very weak current and only a small part of the actual 
output of the machine. 

The weakest output of the machine is obtained by the slow- 
est revolution of the plates. Stronger electrification will be 
secured by pushing- the end of the rod nearer the patient's 
feet and making the plates turn faster. No wooden platform 
surface is, however, a very good conductor. In damp, sultry 
July and August weather the atmospheric leakage of the cur- 
rent may be more rapid than the conduction over the platform 
to the patient. The insulating resistance of the air is dimin- 
ished by the dampness, and a good spark is then difficult to 
obtain. If increasing the machine activity does not suf- 
ficiently increase the patient's electrification, we must better 
the means of getting the current into him. The best that can 
be accomplished in this direction will be done by cutting out 
all bad conducting material between the prime conductor and 
patient, and substituting metal. 

Have the patient hold the brass rod in the hands, if this 
does not interfere with any desired local application, other- 
wise put a metal tray under the patient's feet and let the rod 
rest upon the platform as usual, but connect it with the foot- 
plate by a brass chain. At all times of the year this method 
of metallic contact will produce the most vigorous electrifica- 
tion with a given rate of the machine. In winter time it will 
enable the operator to obtain a maximum current without a 
maximum speed. In the summer time it is a necessity any- 
way. 

If still further means of increasing the current strength are 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 1 53 

required on a summer day, the machine can be dried more 
thoroughly with freshly baked chloride of calcium, the office 
may be closed, and a grate fire or a few gas jets be kept burn- 
ing for a short time to dry the atmosphere, and the small or 
even the largest Leyden jars may be attached to the prime 
conductors and their outer coating connected. 

With these precautions almost any form of desired treatment 
can be given during the worst season of the year. No one, 
however, should employ the Leyden jars until he is well trained 
in the use of static electricity, for a patient would be exceed- 
ingly unlikely to call again if an accident happened through 
the operator's want of skill, although the accident would be 
harmless. 

To add strength to local applications of the breeze, spray, 
and frictional spark, we may have the patient hold the brass 
rod so that the upper end will not be in direct contact with the 
sliding pole but will rest about three-quarters of an inch away, 
and a spark stream of this length will intensify the velocity of 
the flow. 

By some modification of these measures every practical 
increase in the vigor of any form of application may be regu- 
lated with exactness, and to weaken the administration if it is 
too strong these steps may be reversed. 

The spark can be modified in length, thickness, and strength 
by (i) leaking off part of the current through the operator's 
foot, placed for the moment upon the edge of the platform ; 
(2) by turning the machine more slowly ; (3) by removing direct 
metallic conduction and placing the brass rod directly upon 
the wooden platform and (4) farther away from the patient's 
feet. 

. A very mild breeze or spray application may be made by 
simply holding the metallic part of the electrode in the hands 
instead of giving it metallic conduction to the earth. 

A mild spark can be given in the same way, but causes a 
contraction in the operator's wrist. 

It should be noted that in any continuous electrification or 



54 THE ESSENTIALS 01* STATIC ELECtRO-tHYSlCS. 

reeze application, the direct metallic connection with either 
lie hands or feet of the patient produces no sensation what- 
ver. The moment the current is interrupted by any form of 
park discharge the patient must be protected from annoyance 
y the operator. A strong spark given with positive electrifica- 
ion and the rod held in the hand will cause an annoying con- 
raction at the wrist ; but with both hands in contact with the 
od and negative electrification, an ordinary positive spark may 
e given with comfort. If shoes are thick-soled, and are filled 
rith nails in either the sole or heel, sparks may sometimes an- 
oy a patient whose feet rest upon the metal tray. With ordi- 
ary shoes this does not occur. 

The dosage of Leyden-jar currents is regulated by the size of 
tie jar (small medium, or large), by the distance between the 
liding poles, and by the rapidity of the revolving plates. The 
earest equivalent to a high-tension induction-coil current is 
btained from the smallest jars, with the plates revolved very 
1st to simulate the rapid vibrator, and very slowly to simulate 
he slowly interrupted faradic current. Extremely rapid rates 
re best obtained by the use of motor power to operate the 
tatic machine. Slow rates of from fifty to one hundred and 
fty interruptions per minute for muscular contractions are 
est obtained when the machine is controlled by hand. 

The medium jars resemble somewhat the medium secondary 
iduction coils as respects quantity of current, while the largest 
irs may be said to resemble the shortest coarse-wire secondary 
oil. The difference between these jars is a prolific source of 
rgument between those whose electro-therapeutic information 
5 in an embryonic state. Some say that the current from the 
irge jars " causes painful muscular contractions," etc. ; but, as 
matter of fact, an intelligent regulation of the distance between 
he poles and the speed of the revolving plates will enable the 
perator to secure his desired effects with all Leyden-jar 
urrents without any necessity of causing pain with any size of 
ar. 

By regulating, therefore, the manner in which the patient 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 1 55 

receives the current from the static machine — whether by direct 
metallic conduction or through a greater or less intervening 
gap of air or wooden surface — by regulating the rapidity with 
which the plates revolve, and by graduating the management 
of the different electrodes to suit each case, the current can be 
made as gentle or vigorous as desired. 

In a hot, dry room on a crisp winter day, or in a damp room 
on a sultry day in summer, the knowledge of how to govern 
the potential and current supply at will is often an inestimable 
advantage. It is perhaps impossible to set down in writing all 
the various manoeuvres by which an experienced operator con- 
sults his patient's comfort during treatment, but sufificient is 
said above to indicate the general ways in which the beginner 
may proceed and practice will teach the rest. 

Standard Current Tests. — It is not the static apparatus but 
the operator's use of the apparatus which performs the clinical 
work. 

It is essential that those who follow my teachings should 
approximate as nearly as possible the same efficiency in the 
working capacity of their apparatus which I maintain in mine. 

I have frequently observed static machines in other offices 
working at a reduction of twenty-five, fifty and even seventy- 
five per cent, of their normal maximum. Owners have not 
seemed aware of this until it was pointed out. Tests of the 
matter are simple, and each reader can determine for himself 
how far his current efficiency differs from the maximum. The 
current may be wasted in either of three places : inside the 
case, beween the poles, or on the platform. 

Test I. If the machine develops high internal resistance, 
jumps a spark between a comb and collector when in very rapid 
motion, with the negative pole grounded and the positive pole 
connected with the platform, the production of current by the 
machine and within the case is at its maximum. 

Test 2. Short-circuit the sliding poles, start the machine 
into rapid action, and draw the poles gradually apart. This 
test should be made in a darkened room. If the convective 



156 THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 

discharge holds between the balls of the sliding rods until the 
distance between the poles is within a couple of inches of the 
radius of the plates, and if, when the luminosity divides, the 
" fox-tail brush " stands out in well-defined and splendid radi- 
ance from the positive pole, with little or no leakage elsewhere, 
there is no waste worth speaking of at this very important part 
of the machine. 

Every physician should test his apparatus in this manner. 
If the brush discharge refuses to form the " fox-tail " appear- 
ance, or rather an appearance which more resembles the ordi- 
nary whisk broom with its short handle, and jumps across an 
air gap of only four, six, or eight inches, the output of the 
machine is wasted somewhere else, if the first test shows that 
current is generated in abundance inside the case. The place 
can be detected by the eye in a dark room. 

Test 3. With the negative pole grounded and the positive 

pole placed as usual in connection with the platform on which 

the patient sits, start the machine into rapid action and request 

the patient to approach the hand near any part of the platform 

- rod. 

If before the hand actually touches the rod a spark passes, 
the length of it will determine the amount of current waste. 
As the resistance of the air is very great a very short spark 
will indicate some waste, and a spark'only a quarter of an inch 
long would indicate a great deal of waste, with a correspond- 
ing reduction of the therapeutic efificiency of that operator's 
work, no matter if the machine, itself was the most powerful 
and finest ever made. 

When a patient upon thciplatform connected with my own 
machine performs this test, there is absolutely no sensation of 
the slightest spark discharge between the rod and the hand. 
This shows a complete elimination of resistance in the external 
path of the current, and supplies within the patient the maxi- 
mum output of the machine at any rate of revolution desired. 

It is essential to make this plain, for all terms of description 
have relative meanings, and must be interpreted upon a uni- 



THE ESSENTIALS OF STATIC ELECTRO-PHYSICS. 1 57 

form understanding or results will differ. The terms " mild 
spark " and " strong spark," for instance, may convey to dif- 
ferent minds as great a disparity of actual measurement as the 
terms mountain and hill would convey to the dweller in the 
Alps and the inhabitant of the prairie. Unfortunately there 
are no mathematical forms in which to express the dosage of 
general electrification and localized methods, but under the 
teachings of experience and careful study it is reasonably cer- 
tain that all operators can attain sufificient proficiency for 
valuable therapeutic work with the static machine, if they will 
keep it in good order. 



CHAPTER XI. 

STATIC ELECTRO-PHYSIOLOGY. 

The actions of static electricity in various forms of application. The importance 
of familiarity with this branch of the subject. Action upon functions. The 
chief properties of static electricity determined by scientific investigation 
before the discovery of galvanism. Cavallo's accurate report. Sedative ef- 
fects described by Arthuis in 1871. Static electricity as a regulator of func- 
tions. Its nerve and muscle reactions. Its effects upon metabolism and 
nutrition. Mechanical effects of the spark. Vasomotor effects. Revulsive 
effects. Sedative DfifSMS stimulating effects. Relief of pains. Its great service 
in nervous and functional conditions and all diseases associated with malnu- 
trition. Its action upon the deeper tissues of the body. Its great penetrating 
capacity. Leyden-jar currents. Their physiological actions similar to cur- 
rents from improved induction coils. Rapid and slow interruptions, and 
nerve and muscle effects. How to determine the difference between large 
and small jar currents by actual use. A comparison of Leyden-jar currents 
with induction coil currents in practical use. Length of seances. Principles 
governing same. 

The Actions of Static Electricity in its Various Forms of 
Application. — No physician of any school can forget his care- 
ful training in the important subject of drug action. He may 
haply forget something about anatomy and relieve his mind 
of one of the worst bugbears of his college course, but famil- 
iarity with drug action must be continuously cultivated through- 
out every year of medical practice. 

It is equally self-evident that familiarity with electric cur- 
rent action upon and within the living tissues is a basic need 

to the physician who prescribes an electric current therapeu- 

158 



STATIC ELECTRO-PHYSIOLOGY. 1$9 

tically. Post-graduate study of this subject forms the chief 
present resource of the practitioner desiring knowledge, but 
undergraduate schools are slowly taking up the work. 

The physician requires facts about electricity for practical 
medical use and not for mere diversion or prejudice. Among 
such facts those relating to current action are of fundamental 
and never-ceasing importance. 

The constitutional effect of simple static electrification de- 
pends upon existing deviations from normal within the tissues 
subjected to the action of this current. Just as aconite cannot 
break a fever in the case of a patient who has no fever, so the 
static current cannot manifest its predominant action as a reg- 
ulator of deranged functional processes of the nervous, circula- 
tory, secretory and muscular systems in cases which are already 
normal. A healthy man will observe little effect from a static 
administration which would warm, energize, compose and re- 
lieve from a dozen accompanying symptoms a patient who had 
the symptoms to relieve. This may be very elementary teach- 
ing, but experience proves that no fact, however simple, can be 
made too plain. 

Endowed with high potential, and extremely small in vol- 
ume, the physiological effects of static electricity are chiefly 
modifications of the ordinary vital processes without elec- 
trolytic alterations. Static electricity may increase, diminish, 
arrest, or otherwise modify these functional processes. It 
affects secretion, excretion, absorption, reflex action, sleep, 
respiration, circulation and nutrition. Owing to its enormous 
electro-motive force and its power of condensation and ac- 
cumulation, it possesses great diffusiveness, which enables it to 
affect the entire system in a limited degree. 

That static electricity had a decided influence upon the 
physiological functions is not a discovery of our own times, 



l6o STATIC ELECTRO-PHYSIOLOGY. 

but was observed before galvanism and faradism were dreamed 
of. In a work written previous to 1790 we read the following 
remarks on this subject : 

Electricity, strongly communicated to insulated animal 
bodies, quickens their pulse and promotes their perspiration. 
If it is communicated to insulated fruits, fluids, and in general 
to every kind of bodies that are actually in a state of evapora- 
tion, it also increases that evaporation, and that in a greater or 
less degree according as those bodies are more or less subject 
to evaporate of themselves, or as the vessels that- contain them 
are conductors or non-conductors and as they have a greater 
or less surface exposed to the open air. By increasing the 
perspiration of vegetables electricity promotes their growth, it 
having been found after several accurate experiments that such 
plants which have been often and long electrified have showed 
a more lively and forward appearance than others of the same 
kind which were not electrified. 



In 1777 and 1781 there were published in London editions of 
a treatise on medical electricity, by Tiberius Cavallo, F. R. S., 
in which is recorded all that was known in his time of the 
subject in hand. The discerning observations here quoted 
were made at least ten years before the first forshadowing of 
Galvani's discovery of a current with chemical and electrolytic 
properties ; and they are not only remarkable for their accu- 
racy, but for the fact that very little has been added to them 
since. Mr. Cavallo recites as follows : 



The remarks made by philosophers relating to the effects of 
[static] electricity upon the human body in general are the 
following, viz., that by electrization, whether positive or nega- 
tive, the pulse of a person is quickened, the number of pulsa- 
tions being generally increased about one-sixth ; and that 
glandular secretions and the insensible perspiration are pro- 



STATIC ELECTRO-PHYSIOLOGY. l6l 

moted and often restored when they have been entirely 
obstructed. 

It might naturally be suspected that the promotion of per- 
spiration and of glandular secretion was only the consequence 
of the accelerated pulse and not the immediate effect of elec- 
tricity ; but the contrary is easily proved by observing that in 
various cases the quickening of the pulse by. other means, as 
fear, exercise, etc., does not promote those secretions nearly so 
much, if at all, as electrization, and also the glandular secre- 
tions and perspiration are often promoted by electricity when 
applied only to a particular part of the body, in which case it 
seldom, if ever, accelerates the pulse. 

Hitherto it has not been discovered that [static] electricity 
acts within the human body by any chemical property, as 
most medicines generally do ; but its action by which it pro- 
duces the above-mentioned effects may be considered merely 
as a mechanical stimulation, for it seems to act as such even 
within those parts of the body which, especially when diseased, 
are mostly out of the reach of other remedies. . . . 

From these observations it appears that the application of 
[static] electricity does not merely promote any discharge or 
circulation of fluids, but rather assists the vis vita or that innate 
endeavor by which nature tends to restore the sound state. 

It may, perhaps, be ever difificult to explain in what manner 
electricity assists that natural endeavor, but experience shows 
the certainty of the fact, and with it we mus't be gratefully 
content ; for we may apply the effects to our wants, though 
we may be ignorant of their cause and mode of action. 

When an electric shock is sent through any part of the body, 
an instantaneous involuntary motion is occasioned, which shows 
that the muscular fibres through which the shock is sent are 
expanded or in some other manner convulsed. This involun- 
tary motion is also occasioned by sparks. 

Further, when a shock is sent through several substances 
besides the human body, a tremulous motion and an expansion 
is evidently occasioned, as may be shown by many experi- 
ments. 

Now all these'observations may perhaps in a manner explain 
the action of electricity upon the organized parts of an animal 



l62 STATIC ELECTRO-PHYSIOLOGY. 

body by comparing it with the tremulous motion given to 
tubes of any sort through which fluids are transmitted, in 
order to accelerate their passage or prevent any stoppage or 
stagnation which might occur. 

In my essay upon medical electricity it is mentioned that 
from the experience of many it appeared that electrization in- 
creases the number of pulsations about one-sixth ; but having 
made many experiments upon myself, I added the following 
observation in the second edition of my essay in the year 1781, 
and consequently long before Mr. Van Marum's experiments : 
" I do not remember that my pulse was ever evidently accele- 
rated by electrization, and yet I have tested the matter at 
various times and with great diversity of circumstances. In 
another essay I have stated that by repeated experiments, ac- 
curately made by Mr. Van Marum and other ingenious persons, 
it was found that electrization, whether positive or negative, 
did neither sensibly augment nor diminish the natural pulse 
rate in a healthy man. Upon the whole, therefore, it seems 
to be ascertained that electrization does not increase or retard 
the ordinary number of pulsations, and the increase generally 
observed before may have been due to fear or apprehension. 
But I am now informed by Mr. Partington, who has long 
practised medical electricity, that electrization, if not in a 
sound, at least in an unsound state of the body, augments the 
number of pulsations considerably." 

I will here mention a few hints which may promote the in- 
vestigation especially of the chemical action of electricity, viz., 
if it adds any principle to those through which it passes as an 
acid, an alkali, the inflammable principle, etc. 

The observations relating to this point are first, that when 
any part of the body has been exposed to the stream of electric 
fluid it acquires a sulphurous or rather a phosphoric smell 
which it retains for a considerable time; secondly, when the 
stream of electric fluid, issuing from a point, is directed toward 
the palate, a kind of acid taste is perceived. 

Now this smell and taste indicate that the electric fluid 
either alters the parts of the body upon which it excites those 
sensations or that it carries along with it some other principle 
which may perhaps be separated from those substances through 



STATIC ELECTRO-PHYSIOLOGY. 1 63 

which this fluid passes previous to its impinging upon the 
body. 

Whether these effects may be increased, diminished or 
turned to any use, and also whether they are quite indifferent 
with respect to medical electricity, are matters that require 
further experiments and consideration. In various experi- 
ments when the electric spark is passed through air or other 
fluids, especially in the case of tinctures of certain flowers, it 
shows effects similar to those which the inflammatory principle 
or an acid produces upon those fluids. The facts have induced 
various persons to suppose that the electric fluid is phlogiston 
or an acid, or else a compound of both. But considering that 
in those cases the action of the electric fluid as an acid or as 
phlogiston is exceedingly small, and also considering the vio- 
lence with which it passes through the substance of bodies, the 
surface of which it usually burns or melts in a small degree, it 
seems more natural to suspect that the above-mentioned effects 
are produced by that quantity of inflammable or acid principle 
which the violent passage and escape of the electrical fluid 
detaches from other bodies rather than to consider electricity 
itself to be an acid, which seems to be very unlikely on various 
other accounts. 

It is customary in this age of aggressive bacteriology to dis- 
credit the " quacks " {sic .') who were the pioneers in electro-thera- 
peutics, but that Tiberius Cavallo, F. R. S., was a scientific and 
discriminating observer and not an ignorant empiric is evident 
from the mere list of his literary productions which is afifixed.* 

* I. " A Treatise on the Nature and Properties of Air and Other Permanently 
Elastic Fluids ; to which is prefixed atv Introduction to Chemistry," 4to, with plates. 

2. " The History and Practice of Aerostation," 8vo, with plates. 

3. " A Treatise on Magnetism in Theory and Practice with Original Experi- 
ments," 8vo, with plates. 

4. " Two Mineralogical Tables with an Explanation and Index." 

5. " Description and Use of the Telescopical Mother-of-Pearl Micrometer In- 
vented by the Author," 8vo. 

6. " A Complete Treatise on Electricity in Theory and Practice, with Original 
Experiments " in three volumes. 



164 STATIC ELECTRO-PHYSIOLOGY. 

About a hundred years later a French writer, Dr. A. Arthius 
(1871), summed up the physiological effects of static electricity 
as follows : 

It induces an acceleration of the pulse, it is singularly calmant, 
eases the respiration, develops animal heat, augments cutaneous 
transpiration, makes more active the urinary secretion, disperses 
nervous irritation, and gives tone to the whole organism. It is 
the great dispenser of equilibrium to the disturbed balance of the 
system, it increases the vital forces, and augments the energy of 
absorption. In a word, it excites and facilitates the play of all 
the functions. It is regarded by those who use it as the greatest 
regulator of menstruation. The well-being which it instanta- 
neously produces causes those who have once experienced it to 
wish for a repetition of its beneficent effects. 

When, one hundred and forty years ago, it was discovered by 
the Abb6 Menon that the human body loses weight by being 
continuously electrified for five or six hours, he attributed the 
loss to the increase of insensible perspiration and tissue change. 
We now say about the same thing in somewhat different lan- 
guage. 

The teachings of modern investigation upon this subject may 
be fairly stated in the following terms: Static electricity in- 
creases the excretion of urea, and lessens the uric acid in the 
system by promoting oxidation. It increases both the appetite 
and the body weight when the latter has been reduced by 
impaired nutrition. It lowers the blood pressure. In ten to 
fifteen minutes of general electrification, or a few minutes of 
sparks to the spine, a gentle perspiration ensues, accompanied 
by a feeling of well-being. When this reaction has been 
reached the sitting may be ended for the day, in ordinary treat- 
ment. 

Under the influence of static electricity the heart-beats 
undergo a change, viz., if slow, they may increase ten to twenty 
beats per minute ; or, if too fast, they may be reduced in num- 
ber. It tends to regulate functionally deranged temperature. 
Many cases of neurotic, neurasthenic and melancholic condi- 
tions are found to have subnormal temperatures (97° to 97.5° 



STATIC ELECTRO-PHYSIOLOGY. 165 

F.) before electrification. These states it adjusts to normal, 
and the patients then usually improve. 

The static spark causes groups of muscles to jump. It is a 
most powerful stimulus to nerve and muscle function, and 
rapidly imparts tonicity, lightness, buoyancy, and firmness to 
soft, lax, and enfeebled muscular substance. It first causes a 
vasomotor constriction, blanching the skin. This soon gives 
place to a dilatation, and the spot gets red. Frequently a wheal 
is raised, 'with a temporary sense of tingling and irritation, 
which will quickly pass away or be instantly removed by rub- 
bing the part with a little toilet powder. If sparks are applied 
with sufficient persistence to the same area, a mild papular 
eruption will often be caused. 

Devoid as it is of electrolytic action, the power of static 
electricity seems to be chiefly manifested as a regulator of 
ftmctions. It tends to adjust to normal action the heart, res- 
piration, pulse, temperature, oxidation, secretion, excretion, 
nervous irritability, and sleep. It increases metabolism so 
that a person can absorb more oxygen : and this mere improve- 
ment in nutrition is a vast power for good, and alone suffices 
to correct many morbid states : as gout, rheumatism, neuras- 
thenia, neuralgia, anaemia, and various symptomatic derange- 
ments. 

The spark, by its powerful mechanical disturbance, sets up a 
great molecular change and acts as a stimulating massage. It 
thus affects the nutrition of a part, disperses exudation mate- 
rial, and promotes absorption. Thickenings of joints, tendons, 
and muscles, localized cedemas, effusions, etc., are reduced by 
strong, thick static sparks. 

With fine, rapid, frictional sparks may be obtained the bene- 
ficial effects of counter-irritation upon the skin ; and with a 
special electrode a blister may be created in from one to four 
minutes, if desired. 

Sedative or stimulating effects are equally under the opera- 
tor's control, and may be obtained at will. 



l66 STATIC ELECTRO-PHYSIOLOGY. 

Many varieties of pain are promptly relieved by some form 
of static electricity; and if not due to an incurable or persist- 
ing cause, it is wellnigh certain that the pain-killing property 
of this agent will give permanent relief, if treatment is perse- 
vered in long enough. 

As a concluding summary of modern opinion upon the action 
of static currents, I will repeat here an abstract of the report of 
the committee on " Standard Electrostatic or Influence Ma- 
chines" presented to the convention of the American Elec- 
tro-Therapeutic Association, and published in the Times and 
Register, December 29th, 1 894 : 

The committee stated that the report was one of immense com- 
prehensiveness and could only be scratched on the surface in the 
short time allotted. The physiological effects of static electricity 
are pretty much all that are produced by all electricity. It" sets 
free the potential energy of the cells of the human organism. That 
is, it excites the cell in such a way that its inherent energy is lib- 
erated. Its wide range of effects vary with and depend somewhat 
upon the manner in which it is applied. 

It causes contraction of the protoplasm, both animal and vege- 
table. It excites nerve fibres, nerve cells, and nerve centres. All 
of them are excited to functional action and caused to produce 
their separate effects — motor, sensory, special sense, secretory, sym- 
pathetic, vasomotor, etc. 

It has a mechanical action. It disturbs the molecular arrange- 
ment of tissues and causes a new structural arrangement, resulting 
in modifications of nutrition. 

It has a cataphoric action and can be made to transfer metals and 
convey medicaments into the tissues.* 

Its general effects are of great range and astonishing importance. 
They may be briefly stated as follows : It promotes nutrition of 
every part it excites ; produces marked local and general circula- 
tory effects, and stimulates the vasomotor nervous system. It pro- 
motes metabolism and tissue metamorphoses ; creates a feeling of 
refreshment to the system ; causes the reabsorption of exudation 
material of a chronic nature and has a revulsive action upon the 
skin. It is both a cutaneous sedative and counter-irritant, and 

* In 1872 Arthuis described metal transference and advocated the use of silver, 
iron, and other metals in the usual electrodes. Practically no use is made of this 
suggestion. 



STATIC ELECTRO-PHYSIOLOGY. 167 

makes a powerful peripheral impression of great value in neuras- 
thenia. 

The subject of reflex pains is of constant interest to a physician. 
Pains are often referred by patients to points distant from their 
origin. Possibly a pain travels along the path of least possible re- 
sistance, and in its outward path it prepares the way for the return 
of a curative influence along the same path. No matter how far 
from the local irritation a reflected pain may manifest itself, spark 
the sore place and the impression will track the pain to its seat and 
drive it out. We cannot cure altered structure, but we can correct 
functional pains, and often relieve organic pains by setting up 
powerful ingoing impressions and displacing the pain. 

The list of diseases in which static electricity can be beneficially 
employed is a long one. Its great fields are nervous and functional 
conditions. In cases of malnutrition it is an excellent tonic. Neu- 
rasthenia, hysteria, neuralgia, nervous headaches, etc. , are rapidly 
controlled by it. In cord diseases it affords relief from various 
forms of pain, even when lesions are advanced beyond cure. It is 
invaluable in muscular rheumatism, chronic synovitis, and chorea. 
It is one of the best general tonics we possess, and aS such is easy 
and agreeable of application, and can be used in a great variety of 
cases. In the treatment of paralysis of curable forms it is one of 
the most successful agents we have. 

It should be noted, however, for the better understanding of 
those who are not practical electricians, that these interesting 
effects attributed to static electricity are neither invariable nor 
absolute, but depend upon and are influenced by concomitant 
conditions, just as drug action varies under different circum- 
stances. For instance, in a cold office, and with a patient with 
habitually cold extremities and lack of vital warmth, we may 
discover little sign of the perspiration spoken of. It may 
therefore be stated that the demonstrable physiological effects 
upon any given case will be modified by the individual idio- 
syncrasy of the patient, the apparel worn, the state of atmos- 
phere in the room, the electrical output of the machine, the 
method by which it is applied, and the duration of the sitting. 

The great electro-motive force of this current gives it almost 
unlimited power of penetration, accumulation, and diffusion. 
When the machine is in action and we interrupt the continuity 



l68 STATIC ELECTRO-PHYSIOLOGY. 

of the output by a series of sparks anywhere upon the conduc- 
tor, every particle of atmosphere in the room is thrown into 
vibration, and vibration is set up in the tissues of the patient. 
A person now seated upon the platform may feel with his ex- 
tended hand the atmospheric commotion synchronous with the 
passage of each spark, and the person's hair, if sufficiently long, 
will exhibit the same oscillations to an observer. If we im- 
agine every nerve fibre and blood-vessel in the electrified sub- 
ject undergoing the same intense oscillatory stress, we can 
readily understand one aspect of its effect upon circulation and 
nutrition. 

It was formerly the fashion to call in question the penetrat- 
ing capacity of the static current and to claim that its action is 
limited to the surface of the patient's body. It is curious to 
see how such a contradiction became so deeply rooted in the 
literature of electro-therapeutics, for a very simple argument 
will prove the reverse. 

This argument may take several forms, of which it is suffi- 
cient to present one, viz. : It is not claimed that galvanic and 
faradic currents pass only on the surface of the body between 
two applied electrodes. It has long been admitted that they 
both penetrate into the tissues beneath the skin. The resist- 
ance of the air, however, is so infinitely greater than that of 
the skin that neither galvanic nor faradic medical currents will 
pass between two conductors separated 'by an air space of an 
inch or any appreciable portion of an inch. Now, it is well 
known that the static discharge will pass through several inches 
of atmospheric resistance ; and if a patient be seated upon a 
platform at the usual distance from a Holtz machine, but with- 
out any conducting attachment to it, he will be sufficiently 
electrified to yield a perceptible spark. I have frequently 
measured the distance at which the breeze from a point elec- 
trode can be felt, and found it to be upward of forty inches. 
Metallic bodies, thirty or more feet removed from an operating 
machine, are influenced. 



STATIC ELECTRO-PHYSIOLOGY. 169 

i^fter witnessing this exhibition of a power of overcoming 
resistance so enormously surpassing the power of either current 
which admittedly penetrates within the human body, the theory 
of surface limitation is difficult to maintain. A rifle bullet 
that will pierce steel armor will hardly be stopped by a wooden 
shingle. 

Moreover, the original theory of surface action started from 
the physical laboratory and had no relation to action within 
human tissues. 

When we consider the countless evidences of high potential, 
the spark, the . excitation of a Crookes tube which neither the 
galvanic nor medical faradic battery will even glow, and the 
vigorous muscular contractions set up by the interrupted static 
current, we have only to wonder that the curious transposition 
of fact regarding its self-evident voltage was ever allowed to 
find its way into print. 

Leyden-Jar Currents. — The physiological actions are along 
the same line as the actions of improved high-tension induc- 
tion coils. 

It is often stated that this form of static current is in fact 
superior to any coil. It is also sometimes stated that every 
application of faradic currents can be duplicated by Leyden-jar 
currents. In practice these opinions are' not quite true. 

Without taking into account any exact difference of maxi- 
mum potential between coil currents and Leyden-jar currents 
(for the medical dosage will always be regulated to the case in 
hand), it is proper to say that a slowly interrupted current 
from either an improved coil apparatus or Leyden jars will do 
about the same therapeutic work. If a common faradic battery 
is in question it must be stated that the Leyden-jar current 
outclasses it entirely in every respect ; but that is because the 
common faradic battery is an inferior appliance and should be 
no longer considered as a therapeutic instrument. 

When we take into consideration a very rapid interruption 
of the current, then the finer coil apparatus (such as the au- 



170 STATIC ELECTRO-PHYSIOLOGY. 

thor's) presents some qualities which the Leyden-jar currents 
lack. 

Both rapid and slowly interrupted Leyden-jar currents are 
adequate for all therapeutic applications upon the surface of 
the body which relate to ordinary nerve and rnuscle effects. 
But if the physician will test the splendidly even and smooth 
action of the rapid vibrator current from my induction-coil ap- 
paratus by the bipolar electrode held in the hand, and by a 
telephone receiver held to the ear, and then make the same 
tests of the finest Leyden-jar current that can be obtained, he 
will discover that it is inferior for sedation effects upon inflam- 
matory tissues and especially for employment within the pelvis. 
It is manifestly too rough and ragged, and is interspersed with 
secondary discharges, and an unevenness which is inseparable 
from the manner in which the static current is produced; It 
may be used within the pelvis in subinvolution with slow inter- 
ruption, but I would not consider it suitable to gynecolpgical 
practice "with the bipolar electrode for sedative effects. 

Leaving this branch of work aside, therefore, and considering 
external applications for the most part, it remains to say that 
the well-understood physiological actions of coil currents differ 
in no respect of importance from Leyden-jar currents. 

When a slowly interrupted Leyden-jar current stimulates a 
motor nerve it causes a muscular contraction. This contrac- 
tion will be more powerfully manifested at the negative elec- 
trode when both are of equal size. 

The electrodes employed with Leyden-jar currents may be 
either bare metal or covered with sponge or felt, and do not 
differ from those employed with faradic currents. They are 
attached to the terminals of the machine by the usual conduct- 
ing cords, and although a pair of extra long hard-rubber han- 
dles is usually furnished with the machine, they are a luxury 
rather than a necessity, for any handles, or no handles at all, 
will serve the purpose. 

It must also be said that the single pair of sponges which, 



STATIC ELECTRO-PMYSiOLOGY. 1^1 

are the regulation equipment of every machine are but the 
most primitive beginning of a full equipment of assorted elec- 
trodes which the physician will require if he attempts to em- 
ploy Leyden-jar currents for all the purposes of faradic currents. 

If the plates of the machine are revolved very slowly, and 
periods of less than one hundred per minute are regulated in 
current strength to a therapeutic dose, the contractions of 
muscles set up by this means will alternate with relaxation and 
rest, and the nutrition and strength will improve. This is the 
way to restore the function of a partly paralyzed muscle. 

If the plates are made to revolve faster so that the frequency 
of interruption will be several hundred per minute the muscles 
cannot relax and rest, and the current strength, which was 
comfortable before, will now be unendurable and quickly pro- 
duce fatigue and pain, for the muscles will be overworked un- 
less the current strength be reduced to tolerance. 

If, however, the plates are made to revolve still faster so that 
the periods will be somewhat increased and the current strength 
reduced to tolerance by reducing the spark gap, an excellent 
gross-massage effect will be produced by passing the roller 
electrode over the surface of the body. 

If the rate is doubled and the method of general faradization 
is employed, the same effect will be produced with the Leyden- 
jar current as with the induction coil, and if the periods are 
now made very fast and the current strength adjusted to pro- 
duce a comfortable thrill over the surface and mild contractions 
over motor points, a general tonic administration will be made 
which will combine circulatory and vasomotor effects with nerve 
and muscle reaction. 

The physiological effects of Leyden-jar currents are not va- 
ried in their specific nature by different individual properties of 
small, medium, or large jars. The academic discussion of Ley- 
den-jar discharges, and whether they cause " painless" or " pain- 
ful" muscular contractions, does not demand serious attention. 
I have never read anything on the subject which was not con- 



172 STATIC ELECTRO-PHYSIOLOGY. 

fusing to the novice or filled with erroneous statements. Any 
physician can connect a pair of jars of any size and test differ- 
ent regulations of length of spark gap and rapidity of interrup- 
tions, for himself, and five minutes of such information will be 
worth more than all the discussions that have so far been 
reported. 

The fact is that the maximum capabilities of current con- 
densation differ with the surface area of each size of jar, and a 
large jar has a greater capacity than a small jar; but as it fills 
up from the same electric source with exactly the same current 
and is never employed in medicine except with an exceedingly 
small fraction of its utmost capacity, it follows that any expert 
operator can regulate a desired dose so that no blindfolded per- 
son can tell what size the particular jars in circuit are. 

When any Leyden-jar current is properly regulated to a 
medicinal dose and is interrupted with a maximum of rapidity, 
it is a high-potential, high-frequency current, and develops the 
physiological effects attributed to such currents. These are 
described fully in another chapter. 

They unite upon nutrition the good effects of exercise, 
warmth, increased blood supply, and fine vibratory massage. 
They are circulatory, muscular, and nerve stimulant, tonic or 
sedative, according to the manipulation and dose. 

The patient must disrobe sufficiently for the purposes of a 
given application, and moistened electrodes must be placed in 
direct contact with the skin. One or both of these electrodes 
may be held stationary or moved about, but as the methods 
are similar to faradic therapeutics I need not describe them, 
but will refer only to the action during the passage of the 
current. 

It is possible to secure the following physiological . effects 
from rapidly interrupted Leyden-jar currents : They contract 
blood-vessels as well as muscles, increase peristalsis in all non- 
striated muscular fibre, stimulate every part of the nerve, wheth- 
er cell or fibre, excite nerves of special sense, quicken the 



STATIC ELECTRO-PHYSIOLOGY. 173 

circulation and glandular secretion, combat blood stasis, relieve 
congestion, and promote the absorption of effusions and the 
eliminations of products of waste. The processes of oxidation 
are quickened, the elimination of urea, carbonic acid, and water 
is increased, and incomplete food combustion is more com- 
pletely carried on. 

When these rapid vibratory impulses are directed with the 
flow of the blood current they reinforce the vermicular move- 
ment of arteries and the functional activity of nerves. In the 
reversed direction they retard the normal current through blood- 
vessels and nerves. 

These currents relieve pain in the same manner that induc- 
tion-coil currents relieve pain ; they are useful to every pos- 
sessor of a static machine ; but in practice they are very seldom 
employed. The portability and convenience of the smaller and 
eminently satisfactory high-tension induction-coil apparatus as 
shown in Fig. 2 gives it a certain superiority for practical, 
work which the Leyden-jar current does not possess. The the- 
oretical merits of the latter are not denied, and by any physician 
who possesses a good static machine and only a poor faradic 
battery the Leyden-jar currents should be preferred. 

Owing to the fact that it would be a work of supererogation 
to repeat in this part the entire therapeutics and technique of 
faradic currents, I have deemed it sufficient to set forth the 
chief physiological actions and leave those who wish to employ 
Leyden-jar currents therapeutically to pursue the faradic meth- 
ods with which they are already familiar. There is no differ- 
ence worth speaking of in the technique. There is, however, 
one other important reason why they are so seldom employed 
when their merits are admitted. To the man who possesses no 
static apparatus the coil current is the only alternative. But 
the physician who already has at hand the source from which 



174 STATIC ELECTRO-PHYSIOLOGY. 

his Leyden-jar currents would be obtained if he desired to use 
them, has other applications available which dispense with the 
removal of clothing, and which not only do many things that 
the Leyden-jar currents cannot accomplish but include within 
their sphere of action almost the whole practical range of util- 
ity belonging to the more troublesome method. 



CHAPTER XII. 

STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 

Arrangement of patient on the static platform. Management of accessories. 
Positive electrification. Negative electrification. The author's method of 
potential alternation. Positive static breeze. Negative static breeze. Posi- 
tive or negative static spray. Massage roller applications. The static cage. 
Positive static sparks, frictional and percussive. Leyden-jar currents. Gen- 
eral sedative effects. Local sedation with the static breeze. General stimu- 
lation effects. Local stimulation with the static breeze and spark. Static 
polarity effects. Counter-irritant applications. Nutritional applications. 
Muscle contracting methods. Massage, electrical and hand. 

In general, the methods of employing static electricity are in 
marked contrast to the applications of other currents. Instead of 
placing certain tissues, or portions of the patient's body, between 
two electrodes, and affecting chiefly or only the included parts 
by employing a current with a direct circuit flow and little or no 
lateral dispersion, we transform our entire patient into one great 
electrode by seating him upon the insulated terminus of the act- 
ing pole of the machine, producing a complete general electrifi- 
cation, which constitutes the basis of all .static treatment. Upon 
this all local applications are grafted. The other pole is usually 
connected with the earth and disregarded in general treatment. 

When the machine is started into action a separation of the 
collected electricity into positive and negative takes place. 
Each dissociated portion of the electric force, being self-repel- 
lent, strives to escape from the enclosing case of the machine 
by a separate channel, and the result is a continuous flow from 
the higher to the lower potential. The flow from one half of 
the revolving glass plates is carried off to the earth by the 
chain attached for this purpose to the unused conductor, while 
that from the opposite half of the plates is conveyed by a con- 
ducting rod or chain to the insulated platform, where its down- 
ward flow is headed off and a remarkable phenomenon takes 
place. Unable to pass down the glass supports of the platform 

to reach the great negative magnet the earth, the swift output 

175 



176 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS.- 

of the machine accumulates like a fast-rising flood, escaping 
upward and outward at every point where the tension of in- 
sulation gives way. The accumulation from a powerful ma- 
chine is thus sufficient to form a great electric pool upon the 
platform, in which the patient is invisibly bathed, becoming 
electrified with the same potential as the prime conductor to 
which he is attached ; and he is charged everywhere alike 
throughout every tissue, filament, and fibre of his body, for it 
is a law in electrics that " the potential inside a conductor has 
the same value as at any point on its surface." 

There is no clothing to remove, no current direction (ascend- 
ing or descending) to take into account, and no rheostat is re- 
quired to govern the current strength of general electrization. 

The individual upon the platform is simply permeated from 
foot to head, not with a galvanic streak shot through him from 
point to point, but by an electric force of illimitable dispersive 
power, and a penetrating energy that laughs at the resistance 
of the human tissues. 

Without accumulation there could be no therapeutic employ- 
ment of static electricity, owing to the small quantity of the 
current stream. To illustrate this, we may stand the patient 
upon the floor instead of the insulated stool, and place the 
hand upon the conductor as before. 

The cuxTent now flows through the body to the earth at its 
normal rate of strength (quantity), but no crackling sound is 
heard as it escapes, no hair stands erect upon the head, and the 
spark from the largest ball electrode is so small and feeble that, 
to obtain it, the electrode must be held within about half an 
inch of contact. Various tests of this kind may be made by 
each operator for himself, and by personal experimentation 
alone can the physician become intelligently familiar with every 
phase of action of the static machine. 

In placing the patient on the platform it is necessary to see 
that the dress does not drag on the floor at any point to leak 
off the current. 

For practical treatment any ordinary wooden chair with or 



■STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 1 77 

without a back may be employed. A simple cane-seated stool 
is necessary for general purposes. The chair may be any form, 
rocker, reclining or upright, and may be seated with cane or 
leather, but must be devoid of all metallic ornamentation, such 
as fancy-headed nails around the edge. An ordinary steamer 
chair is also exceedingly useful when one is treating a feeble 
patient who finds an erect position tiresome. 

To obtain effects which are both pleasant and beneficial, a 
certain degree of care and experience is required, for, unless 
properly administered and with due regard to circumstances, 
static electricity is liable to prove disappointing. It may even 
be made exceedingly disagreeable ; nay, it may be intolerable 
in the hands of a careless bungler. A great part of the ex- 
pressions of appreciation, pleasure and satisfaction elicited 
from patients is due to the judicious use of the various elec- 
trodes. 

The great variety of effects obtained from static currents are 
to be produced by the great variety of practical manipulations 
of current strength, conditions of treatment, and a few essential 
electrodes, rather than by multiplying the number of elec- 
trodes. 

The traditional umbrella crown electrode is superseded by a 
small group of pointed and fine wires bunched together. This 
produces a concentrated head breeze instead of the diffused 
scattering of the current caused by the umbrella. As a practical 
electrode the large, clumsy, but time-honored umbrella is con- 
trary to the established principles of therapeutic breeze appli- 
cation. 

The improved platform of to-day is the most essential acces- 
sory accompanying the static machine. The ordinary size is 
forty-two inches long by twenty-seven wide and is supported a 
foot above the floor by soHd glass legs. All corners and edges 
are rounded. The early, square-edged, sharp-cornered plat- 
forms, with wooden legs set into common glass cups, leaked off 
a large amount of current, and are obsolete. All who are still 
using such an inferior platform should procure a better one. I 



1/8 STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 

have seen men who deemed themselves very experienced with 
static electricity still use one of these worthless and long since 
rejected platforms, without realizing that they were wasting 
half the current that should have reached the patient. A good 
platform that will insulate the patient effectively is a cheap 
investment and an absolute necessity. 

The author's insulated electrode handler is also a practical 
requirement for the physician. 

Another extremely important accessory part of the static 
machine is the means of connecting the Leyden jars with the 
prime conductors. In one of my former machines these hooked 
directly upon the pole piece, and the hard-rubber supports for 
the sliding rods were solid at the base, and allowed little leak- 
age. My present apparatus, however, was fitted when first pur- 
chased with a jointed rod device, and instead of being solid, the 
hard-rubber knob beneath each pole piece was open at the 
bottom and fitted with a brass screw, into which the jointed 
rod was secured. The result was found to be a leakage so great 
as to be fatal to X-ray work with tubes of high resistance, and 
to reduce the therapeutic efficiency of electrification by at least 
one-fourth. 

So great was the leakage that it was impossible to procure 
between the sliding poles the splendid luminous displays and 
" fox-tail " or whisk broom, which ought to be visible at the 
positive pole in a dark room. It is wise to speak of this point 
because a number of physicians may be employing a similarly 
constructed apparatus without suspecting the reason why they 
cannot equal reported results. This defect has since been cor- 
rected, and can be rectified upon any apparatus of this kind in 
use. 

Physicians accustomed to the administration of electric cur- 
rents created by chemical action are somewhat confused when 
they first attempt the different appHcations of static electricity, 
which will now be explained in detail. 

Positive Electrification. — Seat the patient upon the plat- 
form, with the platform related to the machine so that the brass 



STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 1 79 

rod will conveniently reach from its nearest side to the prime 
conductor. 

It should not be under a gas fixture, or within a couple of 
feet of other office furniture, and as a general rule the more 
free room around the platform the better. 

The side of the patient nearest the machine should be two 
feet or more from the grounded pole, or otherwise a strong cur- 
rent, woollen garments, and the negative attraction may annoy 
the patient with an irritating breeze. 

In hooking the " shepherd's-crook " rod over the positive pole 
it should be hooked with the ball extremity uppermost, and 
close up to the large ball of the*prime conductor, to prevent 
leakage. It is usually thrown over the rod in a careless man- 
ner with the ball projecting downward and toward the machine. 
This is a bad method and wastes the current. The " crook " 
at the end of the platform rod should be bent for practical use 
until the ball and the neck are within an inch of each other. 
As usually furnished by makers it is an ornamental but not 
practical shape. 

Hook upon the negative pole of the machine the free end of 
the brass chain which has already been linked to the copper 
wire passing from the baseboard to the water pipe or gas fix- 
ture. This grounds the negative pole. 

Place a metal foot-plate, or tray, under the patient's feet, and 
connect it with the lower end of the platform rod by a piece of 
chain attached to it for this purpose. 

In this application, and at all times whenever any ordinary 
form of treatment is given upon the insulating platform, the 
sliding poles of the machine are to be draWn their full width 
apart. They are only brought near together when Leyden-jar 
currents are employed. 

Next, start the machine into action and cause the plates to 
revolve as rapidly as they can without either racing or spark- 
ling within the case. 

In dry, wintry weather a highly insulated positive pole will 
sometimes drive sparks between the metal parts within the case 



l8o STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 

and startle a timid patient. Reducing the speed of the machine 
will avoid this, but it should be remembered at all times that 
simple general electrification requires a maximum current 
strength for maximum beneficial effects. 

If no local or other application is made at the same sit- 
ting, positive electrification is usually maintained about 
fifteen minutes, but often requires a longer time for full 
effects. 

Negative Electrification. — Each step of the process exactly 
repeats what was done for pbsitive electrification except that 
the rod is hooked to the negative pole and the grounding chain 
is hooked to the positive. The machine rarely sparks back 
with this low potential polarity, and the patient may either sit 
with feet upon the tray or hold the rod in her hands, while a 
maximum current is ma,intained. There is no liability of caus- 
ing irritation through woollen garments by the attraction of 
neighboring objects. 

Potential Alternation. — The above two methods are a con- 
tinuous general electrification. Potential alternation, as de- 
scribed by the author in 1893, constitutes an interrupted and 
oscillating, vibratory, general electrification. It may be con- 
sidered as adding force to the continuous current, something 
as a hammer blow adds force to continuous pressure, and is a 
more energizing tonic than the primary method. 

Either remove the patient's shoes and place the stocking feet 
upon a reservoir electrode filled, for comfort, with warm water, 
or, if this is too much trouble with high-laced shoes, leave them 
on and insulate the nails in the heels by putting three or four 
folded newspapers between the shoes and the metal foot- 
plate. 

If shoes are worn without such protection the interrupted 
current will pass up the nails and through the soles of the 
shoes, in a succession of sparks, and the tolerance of the feet 
would not permit the current to be made .strong enough to 
affect the rest of the body. 

Next prepare the platform rod the same as for simple positive 




Potential Alternation. A chain from rod B to positive pole D. Patient's 
feet are protected by several large electrical journals placed over the brass tray. 
C is the ball electrode placed upon the standard and grounded by chain to wire E 
passing to gas fixture. The opposite grounding chain F connects the negative 
pole with the head-breeze electrode C, grounding both. G is about three feet 
distant from the patient's head. The dotted lines between C and the terminus of 
the shepherd's crook indicate the spark gap interrupting the current when the ma- 
chine is in rapid action. The usual length of this spark gap is from four to six 
inches. 



i8oA 



STATIC METHOnS-^PRODUCTION OF SPECIAL. EFFECTS. l8l 

electrification, and ground the negative pole. Fix the large 
brass ball spark electrode upon the movable standard and place 
it beside the positive, prime conductor so that the balls of the 
electrode and the " shepherd's crook " will touch each other. 
Ground the electrode to the gas fixture if the negative pole is 
grounded to the water pipe. Different groundings in this case 
are essential. 

Over the head of the patient arrange the head-breeze elec- 
trode, and attach to it the same chain which connects the 
negative pole to the water pipe. Adjust the head electrode 
so that it shall be about three feet distant from the pa- 
tient. 

Start the machine into rapid action and gradually draw the 
ball electrode away from the shepherd's crook so that finally 
the length of spark which passes between the two will cause a 
gentle thrill that does not exceed comfort in the patient's feet ; 
at the same time, vigorous oscillations will be seen in the 
patient's hair. 

The operator may use a single hand to move the spark elec- 
trode. Never tpuch the standard with both hands while the 
long spark is passing. 

The patient must keep both feet flat in contact with the plat- 
form. If one foot is lifted the density doubles as the contact 
area is divided, and hence a current strength that is proper for 
this treatment might be exceedingly disagreeable if concen-., 
trated upon one foot. 

I am often asked what should be the length of spark between 
the interrupting electrode and the positive pole. Spark lengths 
will vary according to conditions, and the dose is not regulated 
by inches. Oscillations should be obtained which will set the 
atmosphere and hair of the patient in that degree of powerful 
commotion which, in a given case, experience demonstrates to 
produce the most sedative-tonic effect. As a matter of fact 
the spark s'treams, which I have often measured to gratify 
inquiring physicians, have varied from three to seven inches in 
length, with an average, probably, of about five. 



182 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

The same method can be pursued with the negative pole, 
but the high potential polarity is more effective and hence 
preferable. 

Positive Static Breeze. — Arrange patient and machine 
attachments the same as for negative electrification, and 
ground the positive pole to the wire near it, which has pre- 
viously been brought from the gas fixture to a situation near 
the machine, convenient for this purpose. 

The breeze may apply a continuous or an interrupted current 
and the electrode may be in motion or stationary. 

For a stationary breeze upon the head, forehead, occiput, 
joint, or any localized part of the spine or body, fix a brass 
point electrode upon the standard and set it at a proper distance 
from the part to be treated. 

For a vertex head breeze, simply swing out the hinged rod 
screwed upon an upper corner of the case of the machine, and 
suspend the small bunch of wires, elsewhere alluded to, over 
the patient's head — twelve to twenty-four inches, according to 
the thickness and resistance of the patient's hair and the effect 
desired. For this purpose my own special head-breeze elec- 
trode consists of half a box of exceedingly fine, French gilt 
hairpins which I wound together at the top with a small piece 
of wire, flared the points slightly apart, and suspended them 
by a foot of copper wire to the extremity of my swinging 
rod" 

When all is ready ground the electrode to the gas fixture 
and start the machine into action. 

Regulation of speed, distance from point to patient, length 
of application, and all that constitutes the dose, depend upon 
the therapeutic indications and. call for operative skill on the 
physician's part. 

A moving positive breeze is administered by attaching the 
brass-point electrode to a chain, hooking the chain to the gas 
fixture, and manipulating the point with rapid or slow sweep- 
ing motions, at greater or less distances, over a given part, 
according to the effect desired. 



STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 1 83 

To apply either a stationary or moving breeze in the most 
effective manner the method taught by the author of inter- 
rupting the current before it gets to the patient is superior to 
the method sometimes employed of interrupting the breeze on 
its way to the earth. This latter method adds no efficiency 
to the treatment, although it will eliminate the irritation of a 
negative head breeze upon a thick head of hair, or through 
woollen garments upon other parts of the body. The author's 
method, however, not only eliminates negative irritation, but 
tremendously accelerates the current force with which the 
patient is electrified. This is one of the rudimentary things I 
demonstrate to all my students. All other steps of the process 
are the same as for a continuous breeze. 

To cause the interruption the patient holds the platform rod 
in her hands, rests the crook conveniently upon the frame of 
the case, in such a way that the rod can be steadily and easily 
held at the distance of an inch, more or less, from whichever 
prime conductor is chosen for the treatment. A spark stream 
will pass between the pole and the rod as soon as the machine 
is started into action. The plates should revolve quite rapidly, 
and by increasing or decreasing the spark gap, the interruptions 
may be made either slower or faster, milder or more vigorous, 
and the intensity of the treatment regulated. Further regula- 
tion is attained by varying the speed of the plates and the dis- 
tance between the electrode and the patient. 

Negative Static Breeze. — All that has been said about the 
method of applying the positive breeze equally describes the 
negative breeze administration, except that the high potential 
positive pole must be connected with the platform. Electrodes 
are grounded and manipulated in the same way as before, 
with only such differences as the more irritating qualities 
of the strong negative breeze through resisting garments re- 
quire. It is not irritating through cotton fabrics or on bare 
skin. 

Positive or Negative Static Spray. — Spray applications 
simply intensify either the continuous or interrqpted static 



1 84 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

Sfeeze by throwing from the point of the electrode manipulated 
by the operator a convective shower of visible electrified par- 
ticles of air. 

For this purpose the electrode must be swept sufificiently near 
the patient, and the development of all the useful sedative, 
tonic, stimulating, counter-irritant, and rubefacient effects of 
which this method is capable calls for familiarity with the 
physiological actions of static electricity, and considerable ex- 
perience and operative skill. 

Massage Roller Applications. — The regulation of intensity 
and muscle effects with this method depends upon the distance 
between the two sliding poles, which are first brought near 
together and gradually drawn apart to increase the current 
strength. 

The electrode is connected to a chain in the usual manner. 
It may then be employed with the following variations : 

1. Attach the chain to either the negative or positive pole, 
apply the electrode to the insulated patient, and ground the 
opposite pole. 

2. Connect the platform and the machine with the rod as 
usual, and attach the electrode to the opposite pole, which is 
also grounded. 

In the above applications the selection of poles is the same 
as for the static breeze. If the patient is connected with the 
positive pole its higher voltage gives greater intensity and' 
heating and counter-irritant effects. 

The poles may also be drawn wide apart and the electrode 
manipulated by the patient over the affected part while the 
operator interrupts the current with the spark-ball electrode 
upon the same prime conductor. 

The roller may be also used with the Leyden-jar current by 
placing the bare feet upon a foot-electrode connected with 
the negative Leyden-jar while the operator passes the roller 
over the surface of the body. In this case the roller is con- 
nected with the positive Leyden-jar and the strength of the 



STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 1 85 

application is regulated by the distance between the sliding 
poles. 

These applications are nearly the same as the short frictional 
spark when counter-irritant effects are produced, but can be 
made to equal a slowly interrupted current to exercise muscles 
in a manner similar to massage. 

The Static Cage. — This, when brought to general notice by 
descriptions in medical journals, has excited the interest of phy- 
sicians, who presumed it to be either a new method or a method 
producing exceptional and superior effects. 

The application of the static breeze to the head and spine, or 
entire body, by a breeze electrode fixed above the patient upon 
a standard, or by the brass point electrode manipulated near the 
patient by the hand of the operator, is about as old as the static 
machine. It has been practised nearly a hundred and fifty 
years. It is a utilization of the law that opposite electricities 
attract each other, and is a means of increasing the rate of 
change in the patient's positive or negative charge, or of local- 
izing the area of diffusion from the entire body to a part upon 
which effect is concentrated. 

When the point electrode is held near any part of the body 
it rapidly attracts off the insulated patient's electric charge, 
and is felt as a breeze upon the surface ; and when the princi- 
ple of the point as an attracting magnet is amplified by multi- 
plying the number of points, arranging them in a circle sur- 
rounding the patient's body, or suspending them like a canopy 
above the reclining person, the result is a diffused breeze upon 
a large area instead of a concentrated breeze upon a small 
area. 

When this method was first brought to my attention in 1894 
it was stated to involve a process of auto-induction ; inductive 
currents being set up in the patients body by the surrounding 
"solenoid." A single personal experience disclosed at once 
the error of this view and revealed the cage as simply an ex- 
panded breeze electrode. Those who wish to make one can 



1 86 STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 

easily do so at a small expense and use it when it may serve. 
No exaggerated value can be attached to it, but it lends variety 
to methods which accomplish about the same result. 

The indications for its use are general functional neuroses 
and diseases associated with perverted nutrition. 

It is constitutional rather than local treatment and adds 
rapidly to the rate of change (current flow) of general electri- 
fication. 

The cage may alarm very timid or hysterical subjects, and 
may be inconvenient to use upon some others. It is best 
adapted to men, or young girls or women who are rather trimly- 
dressed, and who can easily stand within the cage in the re- 
quired manner during the ten or more minutes of the applica- 
tion. 

The effects parallel those attributed to high-potential currents 
of high frequency by French investigators during the past four 
years. The expert can vary the cage application in a number 
of ways, and interrupt the current by approximating the sliding 
poles, or by the author's method of potential alternation. In 
ordinary hands, however, the methods which are simplest and 
serve every purpose are the following : 

1. Negative electrification with either constant or oscillatory 
positive breeze. 

2. Positive electrification with oscillating breeze. 

Have the patient remove shoes and stand in stocking-feet 
upon the reservoir foot-electrode, which should be filled with 
warm water as a niatter of comfort, for a cold foot-plate is dis- 
agreeable to most persons in cold weather. 

From this electrode, connection is made to the platform rod 
and prime conductor of the machine. The rod is placed upon 
the platform in the usual manner. The cage is now lowered 
over the patient so that he or she stands in the centre, with a 
distance of about six inches between the top of the head and 
the chains suspending the cage. 

The prime conductor not connected with the platform is both 
grounded and connected with the metallic cage by the usual 



STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 1 87 

grounding chain, passed first over the sliding pole and then 
hooked to the cage. 

The sliding poles are short-circuited, and the machine is now 
started into action. The poles are next drawn apart about one 
inch. The exact distance is regulated by the sensation in the 
patient's feet, which should not exceed an entirely comfortable 
thrill. If drawn too far apart the spark stream will cease to 
pass between the poles, and this fact also requires that they 
should be kept near together. 

This constitutes the oscillating breeze, and may be admin- 
istered for five, ten, or more minutes, according to the oper- 
ator's judgment. The technique is the same with either pole. 
With the negative charge it is bland and cool ; with the 
positive charge it is more irritating or stimulating if gar- 
ments make it so, but both can be made agreeable to the pa- 
tient. 

It is well to test the milder negative electrification first, as 
patients may be so dressed that the positive charge and negative 
breeze are too irritating to the skin beneath their garments. 
This is most likely to be the case with loosely woven, woollen 
fabrics, metallic hairpins, metallic dress trimmings, and corset 
steels, and no one should treat a patient with the negative 
breeze until he has familiarized himself with the sensations 
set up by different dress goods of higher or lower resist- 
ances. The removal of the outer coat often corrects the 
trouble. 

The oscillatory application requires the passage of a stream 
of interrupting sparks between the prime conductors of the ma- 
chine and is the most effective tonic manner of using the cage. 
The author's method of potential alternation, however, practi- 
cally furnishes the same effect in a simpler way and obviates 
the necessity of employing the more troublesome elec- 
trode. 

To produce a simple breeze it is only necessary to draw the 
poles apart at the beginning instead of sliding them together. 
The current is then continuous instead of interrupted, and does 



l88 STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 




Fig. 22. 

The Static Cage. This diagram shows the author's apparatus with great 
completeness. The patient stands upon the metallic foot-plate filled with warm 
water and connected by a piece of brass chain to the rod passing to the pole of 
the machine. The opposite pole is grounded and the same chain is hooked to 
the cage. The cage is suspended upon the frame and is raised and lowered by 
the stout cord passing through the puUy. When not in use the cage stands upon 
the top of my static machine. The patient may sit upon a stool if desired. The 
cage may be adjusted to any height. 



STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 1 89 

not differ, except in the size of the electrode, from any other 
continuous static breeze.. 

The cage is a " general-electrization " rnethod, and applies to 
the usual range of cases in which static electricity is of recog- 
nized benefit, particularly functional nervous disturbances, and 
is a sedative or stimulating tonic. It is no't especially sug- 
gested in tlje therapeutic, itemized paragraphs of this book, for 
the reason that few possess the appliance, and those who do 
can readily comprehend its uses and employ it as opportunity 
permits. 

Positive Static Sparks, Frictional and Percussive. — Ar- 
range patient and machine attachments the same as for 
negative electrification and ground the positive pole to 
the conducting wire from the gas fixture, or to the chan- 
delier. 

Take in hand the large brass ball electrode, attach to it the 
swivel of the author's insulated electrode handler, hook the op- 
posite end of the chain to the gas fixture, and with a quick 
stroke throw the ball so near any selected part of the patient 
that a single, thick, long spark will pass. Instantly withdraw 
the electrode. 

Repetitions of this act, following each other with greater or 
less rapidity, constitute a spark treatment. Operative skill and 
Judgment regulate all that pertains to dosage in the usual 
manner. 

The short fractional-spark application is quite the oppo- 
site of this, and is made by rapidly rubbing the ball electrode 
over the surface of the patient's clothing so that the current 
will pass through the resisting medium in a fiery trail of sharp, 
needle-like, minute sparks, as long only as the garments are 
thick. 

The percussive spark may be almost any length from one to 
six inches, and is a single discharge. Frictional sparks are mul- 
tiple, and from one-quarter to one-half of an inch only in 
length.. 

A second method of producing a similar trail of pointed darts 



I go STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

consists in sweeping the brass poiiit electrode nearer the patient 
than in administering a static spray, and thereby throwing a 
shower of fine sparks as the point is swept across the surface. 
The brass-point electrode can be made to apply a breeze, spray, 
frictional sparks, or single percussive sparks, with equal effect- 
iveness if the operator knows how. 

Leyden-Jar Currents. — We now leave behind the applica- 
tions of static electricity which are without parallel methods in 
therapeutics, and enter the field occupied by currents from in- 
duction coils, long known as faradic. 

A pair of Leyden jars of one of the three sizes accompanying 
the machine is selected and placed in proper relation to the 
prime conductors. The sliding poles are brought together. A 
pair of the usual conducting cords is connected with the Ley- 
den-jar attachments, and the free ends of the cords are attached 
to any form of electrodes employed with interrupted currents. 
The electrodes must be moistened if they are covered with 
sponge or felt. They must be placed in actual contact with 
the skin, and, so far as relates to disrobing the patient and man- 
ipulating the electrodes, the employment of Leyden-jar currents 
is the same as the employment of faradic currents. The platform 
is not used. There is no insulation. The current is condensed 
within the Leyden jar, and discharged from it to the 
patient, in a more of less rapid series of discharges, which are 
regulated by the operator. The outer coatings of the jar 
must not be connected by the rod which joins them for 
sparks. 

A closed circuit of current flow is established when the elec- 
trodes are both in contact with the patient. 

A slow revolution of the machine causes sparks to pass slowly, 
and, if the electrodes are applied to muscles, will set up slow 
contractions which are marked by great energy and painless- 
ness. The poles may be sufficiently separated toobtaiathe 



Static methods — production of special effects. 191 

desired dose, but will exceed tolerance if too long a spark is 
passed. A range of one-half to two inches covers about the 
current strengths employed. When the plates are more rapidly- 
revolved, the effect varies exactly as faradic currents vary with 
the rate of interruption. 

Rapid revolutions and a rapid stream of sparks produce a 
high-tension current, which may be increased or diminished in 
strength according to the distance between the poles. A 
chapter might be devoted to this current alone if its various 
uses were described, but as it would chiefly repeat what is said 
of the application of all other induction currents, a full account 
would be superfluous. Suffice it to say that it is employed 
precisely as faradic-coil currents are applied, and not only may 
duplicate in the hands of an expert every external application 
customary with faradism, but goes beyond the latter in some 
of its effects. 

The portability of the one and the cumbersomeness of the 
other apparatus, as well as the independence of coil currents to 
atmospheric influences, prevent, of course, the entire substitu- 
tion of the static machine for both faradic and sinusoidal appa- 
ratus, notwithstanding that, so far as mere ability to obtain 
effects is concerned, the static covers about the same range as 
the other two. 

In addition to the usual regulation of dosage when electrodes 
are attached to terminals upon the machine, a shunt may be 
employed and current strength controlled on the reverse prin- 
ciple of the ordinary rheostat. 

Fig. 23 illustrates this current controller, which is a per- 
fectly satisfactory instrument. 

When no local application is required and a general sedative- 
tonic effect is sought the patient should be charged positively 
rather than negatively. The effects, sedative and stimulating, 
are relative expressions of the same constant and chief action 



192 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 




Fig. 23. Leyden-Jar current controller. 

of the static charge as a function-regulator. The effect of 
regulating a state of circulatory ornervous excitement is called 
sedative, and the effect of restoring to normal a state of under- 
activity may be called tonic or stimulating, but both results are 
the effect of the one regulating tendency of the static current 
and cannot be produced unless the patient is in the susceptible 
or opposite state. 

The author's method of positive potential alternation acts 
even more quickly and powerfully as a sedative. I prefer the 



STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 1 93 

positive to the negative charge because I believe it to be more 
energetic in its action. I do not attribute any chemical differ- 
ence to the two polarities. As long ago as 1781, and previous 
to that time, it was fully ascertained that : " by electrization, 
whether positive or negative, the pulse of a person is quickened, 
the number of pulsations being generally increased about one- 
sixth; and that glandular secretions and the insensible per- 
spiration are promoted and often restored when they had been 
entirely obstructed." 

I conclude that when a patient is seated upon the static plat- 
form and charged from the negative prime conductor the differ- 
ence of potential between the charge and zero is very much 
less than the difference of potential between the positive charge 
and zero. 

As the greater difference of potential represents a greater 
pressure force, and consequently a greater rate of change, I 
conclude that it is to this extent more effective in accomplish- 
ing certain results within the tissues ; and as a matter of fact 
this judgment is corroborated by cliriical experience. 

Granted that the therapeutic work of both poles is in the 
same direction, it is evident that the polarity which produces 
the most active rate of current flow under the conditions of in- 
sulation, accumulation, condensation, and atmospheric diffusion 
will be the most active therapeutically. It is my custom, there- 
fore, to employ the positive pole for general sedative effects in 
almost all cases. 

Local Sedation with the Static Breeze. — To secure this 
effect in acute local congestions, irritable states, pruritus, der- 
matitis, tender and swollen joints, acute sprains and injuries, 
the insulation may be negative, the breeze positive, and the 
patient should receive the breeze directly upon the uncovered 
skin of the affected part. 

Seat the patient on the negative platform ; ground the posi- 
tive pole and the brass point electrode to the gas fixture or 
water pipe. With the. plates in moderate action keep the point 
13 



194 STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 

in gentle movement over and around the affected surface and 
beyond sparking distance if congestion or inflammation is pres- 
ent, for sparks should not be applied to these states. 

The distance at which the electrode should be manoeuvred 
should be such as to produce the most cooling and beneficial 
effect, and experience must teach this to the operator. Relief 
is almost instantaneous and is continuous while the breeze is 
passing, but to be made as permanent as possible the applica- 
tion should continue about double the length of time required 
to produce a sense of relief after the breeze is stopped. 

The length of the stance varies in actual practice from five 
to ten minutes in mild cases to fifteen or even twenty minutes 
in more severe or very obstinate cases. This form of sedation 
is applicable to almost any external part of the body, and in 
addition to being exceedingly useful as a local sedative it pro- 
duces a general tonic effect upon the entire system. 

General Stimulation Effects. — The effects of static applica- 
tion are very much more in the nature of nutritional tonic 
action than of mere stimulation. I have had patients report to 
me that their family physician laughed at the idea of their 
being benefited by static electricity, and told them that it was 
only a " temporary stimulant like alcohol," and that " a drink 
of whiskey would do about as much good." The gross ignorance 
of facts a century old betrayed by such commonplace assertions 
will apparently never be educated out of the medical profession 
so long as medical colleges trifle with the great subject of elec- 
tro-therapeutics. 

If a patient is in such a state that what ma.y be called a gen- 
eral stimulation of the circulatory and muscular systems is indi- 
cated, it may be obtained in any one of several ways. 

A general application of a Leyden-jar current to the surface 
of the body will do it. Ten or fifteen minutes of simple posi- 
tive electrification will do it in the mildest degree. A positive 
breeze to the spine with negative electrification will do it still 
more perceptibly. 



STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. I95 

If fusillades of sparks are thrown from the brass point to 
mingle with the spray application the effect will be still further 
increased. If the platform is again connected with the positive 
pole and the spinal breeze applied from a grounded brass point 
electrode the stimulating effect will be intensified in direct pro- 
portion to the power of the current, the proximity of the elec- 
trode, and the resistance of the wearing apparel. 

If sparks are also discharged with the breeze the rate of 
change and consequent stimulation will be increased. If the 
electrode is rubbed over the surface instead of being swayed at 
a distance, greater or less, the stimulation will pass into a de- 
cided counter-irritant effect. 

Efficient muscular stimulation is obtained by any application 
that will contract the muscles. The mild positive spark with 
negative electrification produces contractions which are propor- 
tioned to the spark length and thickness, regulated by increas- 
ing or decreasing the revolution of the plates. 

With positive electrification the spark from the grounded 
brass ball electrode discharges the patient with a still greater 
difference of potential, and the increased voltage gives to the 
spark more pungent, stinging, penetrating, heating, and stimu- 
lating properties. 

None of these effects are, however, of the nature of an alco- 
holic stimulation, which is evanescent and followed by depress- 
ing reaction. They are more nearly comparable with the en- 
during vigor imparted to the tired system by a restful and 
substantial meal. The great basis of value of static electricity 
is a nutritional, rather than a merely stimulating effect. No 
one need remain uninformed of the truths of electro- 
physiology. 

Local Stimulation with the Static Breeze and Spark. — 
Every localized application of static electricity in any form 
tends to stimulate the normal function of the part. The action 
of remedies is to some extent regulated by the existing condi- 
tions within the patient. A hypodermic injection of a grain 



196 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

of morphine would be but a gentle comforter to the victim of a 
cancer who is habituated to its use in such doses. It would 
act as a stimulant to restore the normal sense of well-being 
and cause no effects of narcotism. 

The effect of the same administration to a person either 
sick or well who had never taken a dose of morphine in his life 
would be of a very contrary nature. To some extent, therefore, 
the same applications of static electricity which soothe pain, 
congestion, and inflammation in these overactive states are 
stimulating to the opposite condition ; but the most direct and 
effective stimulation to any local part is secured by exercising 
the muscle functions. 

What is said above in the remarks upon general stimulation 
sufficiently covers this ground. I shall, however, dwell for a 
moment upon the subject of static polarity. 

Very confusing ideas are prevalent among physicians on this 
point ; some considering that the choice of poles relates to chemi- 
cal action, so that they must be as carefully differentiated as 
when employing the electrolytic action of the opposite galvanic 
poles ; some holding the view that having successfully cured a 
case by the masterly selection of the proper pole, they would 
have aggravated the condition if they had employed the other ; 
and some considering the whole matter as hopelessly tangled in 
confusion and ignorance and yet awaiting the conclusions of 
scientific inquiry. 

These views may all be brushed aside. A careful reading of 
the chapter on electro-physiology and the actions of different 
administrations will show that all that need be known on these 
points was pretty fully ascertained when Cavallo wrote of static 
electricity one hundred and twenty years ago. 

It is universally stated that the positive breeze is sedative 
and the negative stimulating. By negative breeze is meant the 
application from a grounded electrode, with the negative pole 
grounded and the patient connected with the positive prime 
conductor. For the sake of simplicity, and to avoid mixing up 



STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. I97 

the teachings upon the subject, this book follows the usual 
statements in this regard. 

As a matter of fact, however, it cannot be repeated too often 
or made too plain that the nature and effects of all breeze ap- 
plications with either pole depend a great deal on the operator. 
I will now state that there is no more sedative application pos- 
sible with the brass point electrode than the so-called " negative 
breeze," if I desire to make it so. Far from being " stimulat- 
ing" and "irritating," it can be made to play like the cool 
zephyr of an ideal spring upon a heated and painful part, or any 
part wherein resides an ache or sense of irritation ; and the two 
conditions which are all that are required to produce this most 
exquisite and refreshing of static sedative applications are non- 
resistance between the surface of the body and the point of the 
electrode, save only the air gap ; and the reduction of the latter 
to about two inches — or, if the machine is in rapid motion, 
three or four inches. 

This application, which is so delightful upon the absolutely 
bare skin, is also exquisitely agreeable through cotton fabrics 
and some of the lighter materials which ladies wear in the warm 
season of the year. It is the presence of thick hair upon the 
scalp and the resistance of woollen or winter garments which 
alone give rise to the prevailing idea regarding the negative 
breeze. 

Physicians who are just beginning their experience with 
static electricity and who imagine that polar effects are chemi- 
cal in their nature, may either read the long-established facts 
or inform themselves by a few simple experiments. 

Polish two pieces of copper wire arid attach to the tips of a 
pair of conducting cords. With a hard-boiled egg, a piece of 
raw beef, and three small dishes, one containing a ten-per-cent 
solution of salt, a second a ten-per-cent solution of iodide of 
potassium in starch, and a third plain water, determine what 
chemical effects really follow when the pieces of copper wire 
are in turn thrust into the egg, then into the beef, and then into 



198 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

each of the solutions, and a continuous galvanic current of any 
given amperage passed for any desired length of time. 

The copper wire should be polished between each experiment, 
and, beginning with a large current which will produce imme- 
diate chemical effects, the physician should reduce the current 
to discover how small a number of milliamperes is required to 
permit a brightly polished positive copper needle to remain in 
a hard-boiled egg for one hour without causing the slightest 
green discoloration. 

Having obtained in this manner some idea of what takes 
place, repeat the same experiments with the static current. No 
further argument will be required. 

Counter-irritant Applications. — Local counter- irritation 
may be effectively applied with superficial and reflex effects by 
the static operator. It is one of the best, if not the very best, 
means of influencing the deeper tissues through the cuticle; 
and it acts almost instantaneously. 

Its reflex actions are all the more pronounced because of the 
fact that every local application is accompanied by an impres- 
sion for good upon the general system. 

Local applications made with the low-potential pole con- 
nected with the platform involve a reduced voltage and are 
therefore less rubefacient in their effects. Those made with 
the pole of higher voltage effect a much more rapid rate of 
change and are therefore more intense and can be made more 
effectively counter-irritant. The principle being exactly the 
same whether the patient is insulated with the negative or the 
positive pole, I shall consider only the latter. 

Seat or stand the patient upon the static platform with direct 
metallic connection to the positive pole. Any and all electrodes 
may be employed and the effect of each is modified (if it is 
wood) because it is a poor conductor, and increased (if it is 
metal) by its better-conducting properties, and by its size, 
shape, and method of manipulation. 

The electrode selected is grounded to the gas fixture along 



STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. I99 

with the negative pole. Start the machine into action. The 
spine, joint, or local area to be treated should be covered with 
fabric of texture which will resist the current, such as coarsely- 
woven woollen goods, mohair, silk, etc. If the patient is not so 
clothed it is a simple matter to throw a piece of fabric kept for 
this purpose over the part. 

I will first refer to the use of the brass point electrode. 
With the machine in fairly rapid action throw upon the part a 
succession of showers of needle spray. If the electrode is rap- 
idly withdrawn to some distance, and is swept up and down, or 
thrown toward the part only at intervals which permit inter- 
current relief from the sharp sensation, the application is ac- 
ceptable to the patient's tolerance. 

It can be made more vigorous or milder by increasing or 
reducing the speed of the machine, and by concentrating or 
diffusing the spray. The sharp, biting discharge should not be 
continuously forced upon the tissues by holding the electrode 
still and at a short distance. Two or three minutes sufiSce to 
obtain the desired effects. 

In employing the grounded brass point electrode with posi- 
tive high-potential electrification the operator should personally 
become acquainted with the differences in sensation, stimula- 
tion, and irritation produced by throwing the point directly 
toward the tissues, by short strokes up and down or from side 
to side, by long sweeping strokes, by rapid and slower move- 
ments, and by holding the point still, at greater or less dis- 
tances. 

Manipulation alters the effect and there is a good deal of 
knack about it. The addition of volleys of sparks thrown like 
a fiery trail in the wake of the spray intensifies the effect. 

The usual sparks with negative electrification are also counter- 
irritant, but in a much milder degree than sparks applied in 
the following manner : 

Connect the platform with the positive pole, and ground the 
negative pole and brass ball electrode or massage roller or even 



200 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

the brass point to the same gas fixture. Any electrode with a 
metal surface may be employed. With the machine in mild, 
or medium, or rapid action, according to the intensity of the 
heating and rubefacient effects desired, quickly advance the 
electrode to contact with the surface of the body and rub it over 
the clothing with rapid passes, maintained only for the brief 
time that the patient can endure the biting sensation, and then 
withdraw the electrode. 

These hot and irritant frictions can be repeated a number of 
times within a couple of minutes. 

The long splitting, stinging spark with the electrode con- 
nected to the negative pole while the patient is electrified posi- 
tively is also powerfully counter-irritant as well as muscle-con- 
tracting. 

The uses of these several means of producing counter- 
irritation cannot be itemized here. The practical physician 
will recognize when such effects will be appropriate to a given 
case, and it is only necessary to have in mind the technique of 
grading local action. 

Vesication can, of course, be produced by simply pushing the 
application to intenser effects, but he who makes much use of 
static electricity soon learns to prefer milder measures and 
practically abandons vesication, blisters, cupping, and similar 
procedures which are more annoying to the patient and vastly 
less efficacious than the simple and beautiful resources of 
electro-therapeutics. 

Nutritional Applications When the chief aim of the static 

administrations is to promote the general nutrition a useful 
starting-point is made by every form of either local or general 
treatment that can be applied. However, general positive elec- 
trification produces a more active rate of change within the 
tissues than general negative electrification, because its voltage 
is higher and it more readily overcomes the resistance of the 
insulating atmosphere and diffuses out of the patient with 
greater energy. 



STATIC METHODS— PRODUCTION OF SPECIAL EFFECTS. 201 

Any form of local application that is familiarly employed to 
improve the functions and nutrition of a part can be extended 
over the general surface of the body to improve the functions 
and nutrition of the whole system. 

The static-cage application and potential alternation are ex- 
cellent nutritional methods. In many cases we are content to 
add to general positive electrification a localized breeze upon 
the great nerve centres of the head and spine which influence 
the functions of the body. 

In other cases of chronic disease with lessened sensitiveness 
and great tolerance of the spark I depend for the best nutri- 
tional effects upon three or four minutes spent at the close of 
the sitting in the application of medium sparks up and down 
the spine, over the great organs of the trunk and the muscle 
groups of the extremities, in fact to the general surface of the 
body below the head. 

Muscle-Contracting Methods. — It requires some form of 
disruptive discharge or interruption of the static current to 
produce a muscular contraction. Leyden-jar currents with 
eith.er rapid or slow interruption represent for this purpose the 
equivalent of induction-coil currents. 

Static sparks of every degree contract muscles to which they 
are applied, and most powerfully so when they strike the motor 
point. The massage roller contracts the muscles over which 
it is passed. An additional method consists in having the pa- 
tient hold an electrode by its hard-rubber handle and press the 
metallic end upon the part to be treated. With the brass ball 
electrode the operator applies a slow succession of sparks to 
any portion of the metallic surface of the electrode held by the 
patient. This does away with the sting of the spark directly 
upon the tissues, and is available in some regions whose anat- 
omy is not adapted to sparks in the usual way, and especially 
if the patient is sensitive. 

When a hand or arm is the part to be treated, a chain may 
be wound around the upper arm, or forearm, or hand, and 



202 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

hooked upon either pole of the machine, serving as the plat- 
form connection. The other pole is grounded, and with the 
grounded brass ball electrode slow interruptions of the current 
are produced by sparks between the electrodes and the prime 
conductor to which the chain is attached. If this is the nega- 
tive pole, the current will be less vigorous and the contractions 
milder than if it is the positive pole. The vigor of the con- 
tractions is also regulated by the speed of the machine. 

If the hand is immersed in a jar of water, and connected 
with the prime conductor of the machine by dropping the tip 
of an ordinary cord into the water, the sparks upon either the 
sliding pole of the machine or any part of the patient's body 
will exercise the arm from the finger-tips to the shoulder. 

Massage, Electrical and Hand. — In some degree every form 
of electrical application with an interrupted current which pro- 
duces a muscular contraction is massage. The muscular con- 
traction of the static spark constitutes a very powerful form of 
massage. 

The application of the roller electrode is so similar in prin- 
ciple to massage that it has long been called the massage 
roller. The application of Leyden-jar currents to the surface 
of the body as in general faradization constitutes a very thor- 
ough and efficient form of massage. 

Rapidly interrupted high-potential currents produce a vibra- 
tory action within the tissues for which there is no counterpart 
in manual massage, and the author's method of potential alter- 
nation involves a fine bombardment of the nervous system of a 
kind and degree which the hand of the masseur is inadequate to 
produce. 

The effects of massage are local and systemic. The physio- 
logical effects are succinctly stated by Bartholow : " The mas- 
seur puts forth more or less muscular power, which at the 
points of friction develop another mode of motion — ^heat. The 
action thus induced in the tissues elevates the temperature ; 
the vessels dilate and an increased quantity of blood enters them, 



STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 203 

and the motion of the blood current is accelerated. The im- 
mediate effects of these changes is to promote the nutritive 
energy of the tissues subjected to friction. This result is seen 
in the improved color, warmth, and volume of the parts. A 
general rise of temperature averaging about one degree takes 
place quite uniformly. The body increases in weight ; all the 
organic functions are performed with more energy, and power 
is gained in every way. 

" Massage in its several forms exercises peculiar effects on the 
nervous system. When an inflamed part, such as a joint which 
can be manipulated, is rubbed with excessive gentleness, the 
sensibility, which was at first so acute that every touch gave 
pain, readily subsides, until, after an hour of friction, it may 
be handled with some roughness without evoking painful sen- 
sation. The state of spasm of a muscle is relieved and relax- 
ation induced by persevering rubbing of the affected muscle. 

" Therapeutically massage is employed in wakefulness and 
nocturnal restlessness, simple headache, neuralgia, hemicrania, 
migraine, spinal pain, paralysis, progressive muscular atrophy, 
chronic joint affections, synovitis, contractions and deformi- 
ties, thickening from inflammatory deposits, neurasthenia, anae- 
mia, hysteria, constipation, rheumatism, etc." 

While speaking of the extraordinary utility of massage in 
certain cases Bartholow also states that "patient and long-con- 
tinued use of the method may often be required." 

The confidence of the medical profession in massage is very 
great. It is in good repute among the laity. Its merits are 
usually set forth by those who pursue the vocation of rubbing 
people in about the following manner : 

Massage is a scientific mode of systematic manipulations upon 
the nude skin of the human body in a passive condition. It includes 
percussion, friction, kneading of the muscles, exercising the joints. 
The physiological effects of massage include the incitement of the 
nerve centres, a healthy rise of temperature, acceleration of the 
blood current to the arterioles, promotion of constructive metamor- 
phosis and the nutrition of tissues; also destructive metamorphosis, 



204 STATIC METHODS — PRODUCTION OF SPECIAL EFFECTS. 

excretion of waste substances and a general increase of muscular 
force. 

Its effects upon the nervous system are soothing ; and by skilful, 
gentle manipulation the acutest pains gradually depart. Under the 
treatment of a scientific operator morbid mental states give place to 
hope and cheerfulness and all the functions of the body are per- 
formed with increased energy, causing those benefited by massage 
to say: "Life is worth living." The most eminent physicians in 
Europe and in America give massage a prominent place among 
topical health-restoring agents and highly recommend it as a valu- 
able therapeutic auxiliary. Therapeutically massage is beneficial 
in the treatment of . . . and similar diseases. 

Sufferers from obesity have been greatly benefited and their 
weight reduced by massage. For weak and sickly children also 
suffering from infantile paralysis massage is the best topical reme- 
dial agent. Persons who are free from organic or symptomatic 
disease, but . are deprived of outdoor exercise, including clergy- 
men, lawyers, and all whose brains are overtaxed will find the 
soothing manipulations of a skilful operator a mental and physical 
luxury. 

No one who will study the physiological action and witness 
the therapeutic effects of galvanic, faradic, and static currents 
of electricity, in the great variety of local and general methods 
by which they may be administered, with their wide range of 
exact dose regulation, will fail to see that every demonstrated 
influence of massage upon the human tissues is included with- 
in the compass of electro-therapeutics ; and the skilled operator 
with fine apparatus can so far surpass the manipulations of the 
hand that all that can be claimed for massage simply demon- 
strates the superiority of electric current action. 

Referring especially to the ordinary applications of static 
electricity for exactly the same long list of diseased conditions 
for which massage is recommended, it may be said of massage 
that it is not usually performed by the physician, but involves 
putting the patient into the hands of a third party, who is often 
destitute of medical education, but who fills the ear of the pa- 
tient with attractive stories and takes all of his money that he 
can get. On the part of the patient it involves disrobing, and 
the sacrifice of about an hour's time for each seatice, and the 



STATIC METHODS— PRODUCTION OF SPECIAL EF'FECTS. 205 

development of effects by a slow and tedious process. In the 
case of pain and acute inflammation of a joint a good operator 
will succeed slowly at best, while a poor operator can easily 
make matters worse. 

The applications of static electricity are made by the phy- 
sician himself. He keeps his patient in his own charge with- 
out outside interference. The patient is not required to dis- 
robe, and the treatment occupies only from five to fifteen min- 
utes. 

Symptomatic relief, especially relief from pain, is obtained 
in a manner as much superior to the processes of massage as 
the electric light is ahead of the old wax candle. 

Massage cannot by any possibility do any good to the patient 
that static electricity cannot equal or surpass. 

Static electricity can do much for many patients that no 
n$isseur has ever dreamed of accomplishing. However, it is 
equally true of both massage and the static machine, that each 
requires an experienced and competent operator; and if the 
patient is confined to his room and is neither able to visit the 
physician's office nor enter a well-equipped sanitarium, the 
masseur can reach him and do him good while the static ma- 
chine cannot. 



CHAPTER XIII. 

INDICATIONS AND CONTRA-INDICATIONS. 

Indications for electric currents. Principles governing ttierapeutic indications. 
Ttie polar theory of disease. Indications for static electricity. Contra-ipdi- 
cations of galvanic, faradic, and static currents. Aggravations by static elec- 
tricity. Precautions after treatment. Relation of common condition to 
success or failure in general electro-therapeutics. Disrobing for general 
electrical applications. 

Indications for Electric Currents. — One of the most per- 
plexing questions to the practitioner in his first attempts to 
employ electric currents relates to the differential indications 
for each, and the choice of methods in particular. The road 
out of this difficulty is exactly the same as that over which 
every educated physician has passed in acquiring knowledge of 
drug indications and doses. 

Every man who prescribes accurately must study his materia 
medica, and the same study of medical electricity will quickly 
settle most of the practical difficulties which confront the be- 
ginner. There are indeed theoretical difficulties which are 
discussed at length by theoretical writers, but these give little 
concern to the clinician. 

Compared with average prescribing, and especially with pre- 
scribing according to symptoms, electricity can often be more 
accurately and successfully prescribed than almost any of the 
drug agents of the materia medica. In many cases of disease 
it is impossible to prescribe any drug until a correct diagnosis 
is made, and over the diagnosis a number of consultants may 
dispute. As a matter of fact many diseased conditions are 
mixed types. 

Whenever any form of electric current is indicated by gen- 

206 



INDICATIONS AND CONTRA-INDICATIONS. 10^ 

era! or local conditions it comes nearer to an exact therapeutic 
weapon in the hands of the expert than any approximately 
equal resource in medicine or surgery. There is less guess- 
work in skilled electro-therapeutics than in drug-prescribing or 
pelvic surgery. 

The same careful study that all physicians are compelled to 
give to the action of iodine, mercury, opium, belladonna, digi- 
talis, and all active remedies is necessary to an equal under- 
standing of the action of galvanic, high tension induction coil, 
and static currents. ■ Nothing else is needed except the study 
of accurately demonstrated facts, and there is no other way to 
obtain the requisite knowledge. 

The indications for the uses of each current are mainly found 
in the record of the demonstrated physiological and therapeutic 
actions of each current. I have condensed these into three 
chapters in this book in the plainest manner possible to present 
the facts, and if the reader will familiarize these chapters the 
question of indications w\\\ be practically freed from perplexity. 
Clinical experience will do the rest. 

In numerous writings, especially in text-books relating to 
general therapeutics and medicine, the physician is confused 
and distracted by vague and unmeaning references to methods 
of electrical treatment, which aim over the head of the general 
practitioner and strike at no definite mark. Some of these 
terms, which mean very little to the physician who seeks clini- 
cal directions for the treatment of a given case, are galvaniza- 
tion of the sympathetic, voltaic alternatives, spinal galvani- 
zation, galvano-faradization of the brain, sub-aural galvani- 
zation, indirect faradization, direct faradization, direct and in- 
direct electrization, plexus nerve current, spinal cord root 
current, electric aura, electric soufiSe, and a score of others 
which need not be repeated here. None of these terms are 
employed in this book, it being the purpose of the writer to 
state plainly the essential details of treatment in terms which 
can be understood by every physician who reads them. 

Moreover, the object of employing electric currents in the 



208 INDICATIONS AND CONTRA-INDICATIONS. 

treatment of disease is to produce known and desired thera- 
peutic effects. I do not regard electro-therapy as a jargon of 
cant technical terms, indefinite galvanizings and faradizings 
of centres, nerves, muscles, organs, and what not, according to 
a dozen whimsical and other irrational theories. I regard elec- 
trical prescribing from the same standpoint as drug prescribing. 

The perfunctory view of static administrations denoted by 
vague references to electrization, aura, souffle, breeze and 
sparks is aimless and fruitless of medical action, while, on the 
contrary, a definite technique for the production ol positive and 
predetermined effects (sedative, tonic, nutritional, stimulating, 
muscle-contracting, counter-irritant) means something intelli- 
gible to the physician. These effects, when they are procured, 
either generally or with relation to special parts, are rational 
therapeutic actions, and can be directed to the treatment of 
disease in accordance with the established principles of medi- 
cine. 

Galvanic and faradic currents from improved and scientific 
apparatus must be regarded in the same way. They will pro- 
duce a variety of ^jf>c2?j upon and within the human tissues. 
These effects can be produced at will— any one or more of 
them — by modifications of the dose and management of the 
treatment. Clinical experience and physiological experiment 
have demonstrated forty or more of these important special 
actions of the different varieties of current dosage, and these 
are set forth in the chapters upon electro-physiology in this 
book. 

He who familiarizes himself with the possible effects of the 
different electric currents, and learns how to regulate each 
form of current to produce at will each form of effect, has at 
command the practical resources of electro-therapeutics in the 
most intelligible and serviceable manner. 

To accomplish this end, the beginning consists in knowing 
how to move the switches, screws, and mechanical parts of the 
galvanic and faradic switchboards to produce at will any de- 
sired dose, to acquire by a few hours' practice the knack, of 



INDICATIONS AND CONTRA-INDICATIONS. 209 

managing the static machine, and afterwards to memorize the 
well-known demonstrated therapeutic effects which dose regu- 
lation of the three great currents will produce. 

The simplicity of proceeding thus far makes ridiculous a 
great deal that has been written in the past about the difficul- 
ties of becoming skilled in this branch of practical medicine. 
The physician has already his general medical education to 
furnish the substantial groundwork, and as soon as he knows 
enough about a battery to adjust the dose, and about effects 
to produce them, he is prepared to develop satisfactory clinical 
experience. This is a practical and correct view of electro- 
therapeutics and indications. 

In looking through about a dozen of the electro-therapeutic 
publications of the last fifteen years, including standard treat- 
ises by both foreign and American writers, I have been aston- 
ished at the immense number of impracticable methods which 
have been given currency by supposed " authorities." Some 
of these methods are described in such a manner that no one 
can tell how to repeat the application ; some of them are so 
eccentric and crude that they must of necessity have failed 
to serve their intended purpose even in the hands of the origi- 
nal " authority." 

Others (particularly needless forms of galvanic and faradic 
puncture) are ingenious forms of torture. Some go to the 
extreme of making one current serve purposes for which other 
currents are better suited, and many methods are so vaguely 
stated that they pad out large books but instruct no readers. 

Some authors " faradize " almost every patient, some " gal- 
vanize," and some " cauterize," and exhibit much ingenuity in 
referring to impracticable methods which smack of the desk 
and can hardly be put to clinical uses. Enthusiastic advo- 
cates of local methods which require the application of moist 
electrodes to very inaccessible portions of the body make the 
mistake of assuming that the results which they obtain with so 
much difficulty (both to themselves and the patient whom 
they require to disrobe) could not be just as well obtained 



no INDICATIONS AND CONTRA-INDICATIONS. 

rith. half the trouble by familiar and superior methods with 
urrents which require no disrobing. 

If. these " dead-wood " directions could be purged out of 
xisting electro-therapeutic literature the subject would be 
xtraordinarily simplified and the practical gain to physicians 
^ould be very great. 

Another remarkable feature about electro-medical writings 
3 the prevailing habit of calmly asserting an ignorance of the 
ntire profession about matters of long demonstrated knowl- 
dge of which the speaker or author himself happens to be 
gnorant. Readers who accept at their face value the hun- 
Ireds of such assertions of ignorance that have been made 
luring the past ten years must lose heart before attempting 
o acquire any satisfactory information concerning practical 
lectro-therapeutics. 

I have now before me a single column just published by a 
(hysician who is perhaps the best known electro-therapeutist 
n his own State, which contains three of these common errors 
if assuming the non-existence of facts which have been de- 
nonstrated over and over again for several years. 

It is almost impossible to take up any book or extensive 
ournal article dealing with the subject of medical electricity 
n which the author does not disclose some more or less glar- 
ng ignorance of either improved apparatus or the physiolog- 
cal action of some one or more of the different currents. 

Exempt from this statement is the small group of careful 
,nd methodical men who write close to the line of their own 
)ractical experience, and who have been in the van of progres- 
ive development of this branch of medicine. 

It certainly requires a greater amount of knowledge to steer 
lear of the mistakes and unreliable directions recorded in 
;reat numbers in outstanding literature than to apply success- 
ully in ordinary practice the few principles of technique 
vhich cover the useful range of electro-therapeutics. 

There are many things which can be accomplished by the 
iction of electrical currents which it is not worth while to 



INDICATtONS AND CONTRA-INDICATIONS. 211 

accomplish by their aid, for by other means in medicine and 
surgery we can secure as good or better results more easily. 
In other cases electricity is simply on a par with other meas- 
ures and the practitioner will prefer the means with which he 
is best acquainted. The practical scope of electro-therapeu- 
tics, therefore, lies far within the extremes of current action 
and is limited to the treatment of cases in which electrical cur- 
rents possess clinical superiority. This fact alone brushes 
aside at once nearly half of the troublesome methods of tech- 
nique described by voluminous writers who exhaust one 
remedy at the expense of better. To appreciate how much 
a judicious sorting of clinical methods is needed by the prac- 
tical physician one has but to read any of the electrical text 
books of a few years ago, and especially the European works 
which go to extremes with galvanic and faradic currents. 

Some thirty years ago the choice of polarity was for a time 
reduced to a very simple basis by a group of men who lectured 
about the country and treated patients as they went. About 
a dozen of them published small books which described some 
of the commonplaces of curative results as among the magical 
wonders of electricity and at the same time illustrated the 
most inferior forms of faradic batteries from which some of 
them obtained both galvanic and coil currents, or, as they 
expressed it, " pure electricity " and " magnetism." 

They simplified all diseases into electro-positive and electro- 
negative and applied the positive pole locally to all processes 
which were under-active and the negative pole to all processes 
which were over-active. About a year ago I published a care- 
ful synopsis of these theories taken from a work published in 
1869. Writers of the same class also employed "unequal 
cords " and aimed to subject the tissues entirely to the action 
of a single pole by connecting it to the battery with two yards 
of copper wire while the opposite pole was connected with 
one yard. 

These theories crop out anew in our own time, and but re- 
cently I have seen the long and short cord idea published in 



212 INDICATIONS AND CONTRA-INDICATIONS. 

a Medical Journal as if it was something not only valuable but 
new. None of these antiquated theories could apply to either 
induction coil currents, the interrupted galvanic current, or 
static electricity, and much of the mysticism imparted to med- 
ical electricity by visionary lecturers from 1840 to 1875 has dis- 
appeared under the development of industrial electricity since 
1885 and the discovery of exact scientific laws which control 
the action of all electrical currents. The management of 
electrical machinery in any form is now as practical as the 
management of other machinery, and clinical experience has 
established a rational and practical electro-therapy which is 
much less complicated than that of yore. 

The theoretical range of therapeutic indications for static 
electricity is nearly as wide as disease itself, for at some time 
in almost every important deviation from health it can be 
employed with benefit to the patient, if the physician and 
patient so desire. It may be usefully prophylactic before 
lessened tissue resistance furnishes the nidus for definite dis- 
ease; it may in some form palliate, and in other cases cure, a 
great many states of sickness which are not toxic or febrile ; 
and when no active part befalls it in acute stages it will do 
much to shorten a tedious convalescence. 

In the surgical office it will light up a Crookes tube more 
radiantly than any other present means of electrical excitation 
and with the flouroscope or photographic plate make the ex- 
amination of fractures, dislocations, and a variety of bone 
lesions more satisfactorily and instantaneously than any other 
means. 

It will often relieve the nerve and muscular effects of trau 
matism, allay local inflammations, subdue pain, restore the cir- 
culation to contused parts, quicken the reparative processes of 
nature, increase mobility of stiffened muscles and joints, pro- 
vide a superb form of passive motion and massage, excite recu- 
perating contractions in muscles paralyzed from injury or the 
inaction of splints, tone up and strengthen the patient, and, in 
expert hands, will render with quick facility, and, with far less 



INDICATIONS AND CONTRA-INDICATIONS. 21 3 

trouble than any other equally efficient procedure an immense 
amount of invaluable aid. 

It is the most extensively useful single instrument now em- 
ployed in medical office practice for the relief of non-operative 
and non-septic conditions, and is absolutely without athera-~ 
peutic rival in the complex and useful nature of its achieve- 
ments. 

It may be granted at the outset that certain conditions 
of disease and certain pathological states will never, or very 
rarely, enter into the consideration of static electro-therapeu- 
tics, so long as its employment is inseparable from the phy- 
sician's office. Acute infectious fevers and contagious diseases 
are examples. Such affections as are in an acute stage are ren- 
dered worse by exposure to outdoor air are of course other 
examples, and also cases in which neither of these conditions 
operate, but which are accompanied by symptoms which ren- 
der recumbency and rest essential. 

Thus by a simple elimination of classes of cases, such as will 
occur to the mind of every experienced practitioner, including 
conditions in which the result of time-tried remedies leaves 
little or nothing further to be desired, we define the limita- 
tions which practically determine the uses of static electricity. 

We, therefore, find its chief field of usefulness in the treat- 
ment of conditions, either acute or chronic, which have to do 
with nerve action, circulation, muscles and joints, pain, func- 
tional processes and nutrition. 

From the standpoint of pathology its tissue action is very 
narrow, but so is that of iron ; but both iron and static elec- 
tricity become of immense practical usefulness from the com- 
monplace fact that a great many people present the conditions 
which they favorably affect. Phosphorus cuts a much wider 
swath through the human tissues in its physiological action 
than does iron, but fifty patients need ferrum where one needs 
phosphorus. 

Yet, operating within the boundary of its proper restricting 
limitations, it will be observed that the same static machine 



214 INDICATIONS AND CONTRA-INDICATIONS. 

will accomplish much more in some hands than in others. 
There are in every department of mechanics certain workmen 
who have the knack of getting exceptional work out of ordi- 
nary tools. I have seen watchmakers with an elaborate outfit 
of costly implements whose skill in using them was much less 
than their cost, and I have seen others with but a few plain 
tools who would handle successfully any job on the workbench. 

This difference in the native knack of men will always influ- 
ence both the variety of work done by the static machine and 
the satisfaction with which it is utilized in individual practice, 
for it cannot be too strongly impressed upon the mind that it 
is the presiding genius and personal ability of the operator, 
and not the intrinsic resources of the machine, however great, 
on which rests the successful.application of static electricity. 
This is the explanation of many of the failures and disappoint- 
ments recorded against the static machine of some years ago, 
and it is equally in force to-day. 

Contra-indications. — The thoughtful consideration of every 
physician is invited to this phase of the subject of medical ' 
electricity. When the indications for selected methods of 
electrical treatment are properly understood, and an intelligent 
idea of contra-indications is obtained, a great step is taken 
toward rational therapeutics. 

It is one of the misfortunes attending the lack of under- 
graduate instruction in electro-physiology that many patients 
to whom the resources of medical electricity would be an in- 
estimable boon are deprived of its beneficent action through 
erroneous medical advice. There is certainly no other branch 
of therapeutics which suffers so much injustice through. lack 
of information concerning its actual merits. 

This being the case, it is a matter of great regret that the 
entire medical profession is not so well informed upon the 
physiological action of all electric currents as upon the actions 
of leading drugs. 

Galvanic — The contra-indications of galvanic currents in 
gynecological work are completely set forth in tlie chapter upon 



, INDICATIONS AND CONTRA-INDICATIONS. 215 

electro-diagnosis. It will be observed that these contra-indica- 
tions follow certain principles which may equally be applied 
to the surface of the body or any other tissues outside the 
pelvis. It is a waste of time to employ the galvanic current 
when it will not do as well as induction or static currents,and 
while the discriminating use of each current is not based upon 
actual contra-indications from the standpoint of possible harm, 
yet the study of the chapters upon electro-physiology and 
therapeutic action will give valuable help in enabling the phy- 
sician to select the right current at the right time. 

Whenever a galvanic current is employed it can be so modi- 
fied as to be free from injurious actions by following the rules 
given in this book. 

Faradic. — Induction coil currents from improved apparatus ' 
are quite a different matter from the popularly known faradic 
current in general use. The question of contra-indication is 
therefore entirely different and the teachings of the past are 
now subject to many exceptions, particularly as regards the 
uses of coil currents in inflammations. Hardly any old work 
upon electricity can be opened without finding warning against 
the use of the faradic current in many conditions in which im- 
proved induction coil currents are now one of the best rem- 
edies. Readers are many times warned that the faradic cur- 
rent is painful in cases in which we now employ it to soothe 
pain and allay nervous irritability, As, however, the induction 
coil and Leyden-jar currents possess similar therapeutic actions, 
I will consider them both under the head of Leyden-jar cur- 
rents in my remarks upon the contra-indications for static 
electricity. This will save unnecessary repetition. 

Static. — While the indications for different forms of static 
electricity cover the general range of usefulness set forth in 
the chapter on physiology, yet the contra-indications are sel- 
dom concisely stated. They are as follows : 

General Electrification. — A careful study of the action of 
general electrification upon the pulse, temperature, respiration, 
and secretions demonstrates that there is no state of the tis- 



2l6 INDICATIONS AND CONTRA-INDICATIONS. 

sues in which it would be essentially injurious — there being no 
state of disease in which a regulation of the functions to nor- 
mal is contra-indicated. 

Clinical experience demonstrates that general electrification 
acts without harm, and with benefit, in all diseased conditions 
amenable to curative treatment, whether they are acute or 
chronic, febrile or the reverse. 

General electrification will not benefit perceptibly a person 
who is already in sound health, and patients who exhibit any of 
the conditions which prevent office visits do not present them- 
selves for static treatment ; hence these are negative contra- 
indications. 

Positive contra-indications to general static electrification can 
hardly be said to exist, for it produces no injurious effects upon 
the human system. It is as harmless in acute inflammations as 
in chronic diseases, although medication supersedes it for vari- 
ous reasons. 

The Static Breeze. — Contra-indications can hardly be said 
to exist for purely sedative forms of the static breeze. These 
can have no possible injurious effects, and the only contra- 
indications can refer to the fact that when other measures are 
needed it would be a waste of time to employ an application 
which was not the most effective that could be used. 

Passing from the sedative to stimulating, rubefacient, and 
counter-irritant forms of the breeze, it suffices to say that both 
indications and contra-indications conform to the general prin- 
ciples of medicine, and do not differ because the agent which 
produces these effects is an electric current instead of a drug 
formula. 

The Static Spark. — The great contra-indication for power- 
ful static sparks is the same which forbids mechanical violence 
of any other kind. There are, however, modifications of the 
static spark, so that contra-indications undergo equal modifica- 
tion ; and in many cases of disease, when the pressure of the 
hand cannot be borne without pain, a mild static spark will 
allay the pain, restore local nutrition, and bring about sympto- 



INDICATIONS AND CONTRA-INDICATIONS. 21/ 

matic relief in many cases, and an entire cure in some cases. 
This is a common clinical experience. 

Leyden- Jar Currents. — If it be granted that the operator 
conforms the application and dosage to the therapeutic require- 
ments of the case, it can be also be said that positive contra- 
indications do not exist. A strong current is of course contra- 
indicated when a weak one is required, a slowly interrupted 
current is contra-indicated when the physiological effects of a 
rapidly interrupted current are sought, an application with 
labile electrodes may serve in one case while another case 
would require that the electrodes were stationary — and so on 
through all the gradations of electro-therapeutic administra- 
tions, we may balance one method against another, and finally 
find that there is scarcely a patient who could not be treated in 
some way by some form of static electricity without harm and 
with more or less benefit. 

The harmlessness of this agent when applied with due regard 
to indications cannot be too fully understood by the medical 
profession, however some may regard the demonstrated clinical 
results. It is reassuring to feel that there is no risk whatever 
in treating a patient whom we may not feel certain of doing 
decided good, but whom we should be very reluctant to harm 
in the slightest degree. 

For many years statements regarding the danger of other 
. electric currents have crept into medical literature and serve to 
influence the majority of the profession to apply the same 
reasoning to static electricity. 

Many of the authors who wrote in former days would now 
employ improved apparatus and would revise their statements 
if they were living. 

In a popular work on the subject of electro-therapeutics 
published in 1888 the author of it refers to the indications for 
"galvanism " in a certain disease and speaks of " faradism " in 
the following manner : 

Whenever the mistake has been made of using faradism 



2l8 INDICATIONS AND CONTRA-INDICATIONS. 

in- , serious loss and injury have been suffered. The prime 

need Iz, "or a sedative, and directly opposite in effect is the in- 
duced current, which but adds fuel to the fierce flame of dis- 
ease. It should never be employed in this disease, not even 
is an application to parts distant from centres. 

The lamented author of the work in which this now obsolete 
paragraph appears was on a point of revising it when he died. 
T//e sedative effects of improved high-tension induction coils rep- 
resent one of the distinct advances in electro-therapeutic appa- 
ratus since 1888. 

I have now a report from a physician who has successfully 
treated a case of the same disease referred to above with the 
modern sedative induction-coil current. It ought to be gener- 
illy recognized that the contra-indications which definitely 
ipply to a particular battery, or current, or dose, or method, 
ar to maximum administrations, may not apply to different 
;urrents, different apparatus, and intelligent modifications in 
scientific electro-therapeutic treatment. 

Aggravations by Static Electricity.— Once in a while some 
ivriter reports that static electricity aggravates the disease. 
He means, rather, some form or dosage of static electricity, 
ind generally the spark — which is contra-indicated in condi- 
:ions in which mechanical violence is contra-indicated, but 
vhich is not seldom ignorantly employed, both when it should 
lot be used and in ways that it should never be used ; for the 
spark can easily degenerate from a valuable therapeutic meas- 
are into mere brute force. 

Moreover, the spark is by no means the whole of static 
;lectricity. I once knew an old lady who was fond of stating 
:hat " she did not like fish." She also claimed to " hke meat." 
3n careful inquiry in regard to particular kinds of these foods 
[ found that she admitted the ability to eat with relish six in- 
lividual kinds of fish, and really liked only three different kinds 
)f meat. When the spark is not acceptable with relish (thera- 
)eutic benefit) almost the whole field of static electricity is 



INDICATIONS AND CONTRA-INDICATIONS. 21 g 

still left from which to choose a form of application to suit 
the case. 

In one of the opening chapters of this book I have shown 
that a prominent electro-therapeutist of national reputation 
and since deceased, stated in 1892 that he "had abandoned 
the static spark as a pain-killer, believing that in a majority of 
cases, no matter how skilfully handled, it is as apt to aggravate 
as to relieve." 

Such statements mislead the uninformed physician. It is 
impossible to regard them in any other light than as a declara- 
tion on the part of every such writer that he has not carefully 
studied electro-physiology and the action of the percussive 
spark, and has not been guided by indications, but has applied 
the spark without regard to indications. Mere skill in the 
manipulation of an electrode does not offset the injurious effect 
of setting up a violent perturbation in tissues that are moan- 
ing for soothing rest. 

Practically speaking I never aggravate a patient with static 
sparks. It is needless. I never fail to advance with caution 
in the treatment of every state of doubtful pathology, and every 
strong spark that I administer has had predecessors to make a 
reconnaissance with milder force. At the first sign of a contra- 
indication I stop the spark, but I know so well in advance 
when sparks will do good and when they will not that my 
experience with even momentary aggravations has become 
exceedingly limited. 

However, when a pathological state protests against a tenta- 
tive spark, a brief application of the sedative breeze imme- 
dately removes the first and last vestige of irritation, and there 
ends the aggravation. I cannot conceive the possibility of 
my persistently hammering away with strong sparks at sitting 
after sitting upon tissues that were indicating by every possi- 
ble means they could express, the use of some other method. 

The therapeutic principles are too simple and clear to justify 
any such procedure. If the operator errs through ignorance 
at the outset of his experience, as he sometimes errs in the 



220 INDICATIONS AND CONTRA-INDICATIONS. 

dosage of drugs, he should strive to learn better by studying 
the subject. 

Precautions after Treatment.--Some physicians keep their 
office very warm and some patients wear very warm clothes. 
When these conditions are combined with an energetic appli- 
cation of static electricity a sensible perspiration is set up 
and should be allowed to subside before the patient goes out 
into an atmosphere which is liable to cause her to take cold. 
Aggravations sometimes occur from this cause and especially 
when the patient steps from the office to a street-car and is 
subjected to draughts. Ten minutes of rest in the reception- 
room is a wise precaution in every case in which perspiration 
has been induced. 

Relation of Common Conditions to Success or Failure in 
General Electro-Therapeutics. — There are three prevalent 
conditions which occupy an important relation to electro- 
therapeutics and call for special remark. These are anaemia, 
chronic gastric ill health, and a state popularly known as bili- 
ous or malarious. 

Electricity holds a subordinate place in their ordinary treat- 
ment. In most cases of anaemia the action of iron, arsenic, 
and other chief drugs, administered three times a day, is much 
more rapid and satisfactory than static electricity alone when 
it is administered but three times a week. Electric currents 
do not take the place of haematic remedies, nor of proper 
medication for gastric and hepatic derangements, though elec- 
tricity is certainly not without beneficial action in assisting 
the functions of the digestive organs. Dependence upon it 
alone is, however, a cause of disappointment in many cases, 
and the secret of failure to repeat the results of successful 
operators is often to be found in a torpid liver or neglected, 
gastro-intestinal complication. 

It should, therefore, be the first duty of the physician who 
is about to employ static electricity by general methods for its 
tonic or nutritional effects to combine suitable and necessary 
medication to put the patient in a state to receive the full 



INDICATIONS AND CONTRA-INDICATIONS. 221 

benefit of the influence for good that is exerted by electriza- 
tion upon the nervous system, which in turn will then proceed 
to improve the whole body. 

Disrobing for General Electrical Applications.— A careful 
study of the causes which operate to render general electrical 
applications distasteful to patients, and repugnant to physi- 
cians in ordinary office practice, places disrobing in the front 
rank and leads me to emphasize here an advantage possessed 
by static electricity which is of surpassing and even incalcu- 
lable importance in practical electro-therapeutics : it requires 
no removal of clothing. 

Minor or limited local applications of galvanic and faradic 
currents may readily be accommodated to the necessity of 
surface-contact electrodes, for exposure of the person can 
either be avoided or restricted in extent. But both physician 
and patient may well stand aghast at the mere thought of 
general administrations of any form of electricity which in- 
volve both the drawbacks of disrobing in an office, and the ap- 
plication of the hand or moist electrodes to the entire person. 
These drawbacks, relating both to the disrobing and to the 
treatment, cannot be appreciated at their full weight without 
experience with cases suffering from pain, deformities, para- 
lytic affections ; or fashionably attired women, or persons 
whose failing faculties, crippled conditions of limbs, or sensi- 
tiveness to the appearance of undergarments make it difficult, 
embarrassing, or practically impossible for them to undress 
and dress themselves again in an office. 

To the therapeutist who recognizes the usefulness of general 
electrization in a large proportion of all cases in which elec- 
tricity is indicated at all, it is simply despair to contemplate 
galvanic and faradic methods for constitutional, tonic, and 
nutritional effects. 

The usual alternative in practice is to disregard them and 
wholly ignore the benefits they would produce. This alterna- 
tive does not confront the possessor of a Holtz machine, and 
the facility with which an expert can by its aid employ the 



222 INDICATIONS AND CONTRA-INDICATIONS. 

resources of general electrization without any of the loss of 
time and inconvenience of disrobing, puts the stamp of practi- 
cal superiority upon a form of current whose properties are 
peculiarly adapted to general administrations for sedative, 
tonic, alterative, restorative, and nutritional effects. 

A considerable clinical experience convinces me that I can 
treat ninety per cent of cases amenable to benefits from any 
form of general electrization more successfully, quickly, and 
with more permanent satisfaction by the aid of the static 
machine than by currents requiring the application of elec- 
trodes to the body. 

Granted an equal therapeutic value, the current which may 
be applied through the entire clothing possesses an advantage 
over all others. It is this advantage which belongs to the 
static machine and which places it prominently among the 
necessities of a complete electro-therapeutic equipment for 
general medical and surgical practice. The indispensability of 
both galvanic and faradic apparatus has long ceased to be 
open to question, and when the technique of the third great 
therapeutic instrument is once mastered, it will be found 
equally indispensable. 



CHAPTER XIV. 

ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 

Scope of electro-diagnosis in practice. Motor points. How to locate motor 
points without a chart. Galvanic and faradic reactions in pelvic diseases. 
Their diagnostic value. 

A FEW words on this subject will clear away some of the 
confusion that pertains to it. There is no known method of 
" diagnosing diseases by electricity," as the average physician 
understands the word diagnosis. Many of the conclusions of 
experimenters in the study of electro-diagnosis are erroneous 
or of no practical value. In the treatment of patients a number 
of things may appear which confirm or alter previous diagnosis, 
or affect views of the prognosis of the case, and occasionally 
some test of the electrical reaction of a part may be made in 
advance of treatment, but the complete examinations of nerve 
and muscle reactions set down as necessary in chapters upon 
electro-diagnosis do not enter into practical medicine. 

The diagnosis of the general practitioner may be made by 
the usual clinical methods and treatment instituted accord- 
ingly. During electrical treatment we may find an unsuspected 
area of great sensitiveness, or great dulness of sensation, or we 
may find that muscles contract less quickly than in health, or 
that the results of the method we have selected do not prove 
satisfactory. In all these cases we must look for the cause and 
diagnose the condition by the familiar methods of practice. 

The electrical irritability of nerves and muscles may differ in 

two ways ; in quantity or quality. I know of nothing in the 

literature of medical electricity so lacking in practical value 

and so totally useless to the physician as the laborious efforts 

that have been made to develop electro-diagnosis. Much 

223 



224 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 

attention has been given to the subject by ingenious and 
devoted men, but their work has availed little. As a curative 
agent, as a palliative of symptoms in incurable cases, as a means 
of deciding from the results of treatment between two suspected 
but undetermined conditions, and as a help in arriving at an 
early prognosis, medical electricity possesses a value which 
easily places it in the front rank of extra-drug remedies, but 
there is no system of electro-diagnosis of general diseases, such 
as make up.the routine of office practice. As a matter of fact 
I would about as soon think of questioning the patient in the 
Sanscrit language to obtain a history, as to put him through the 
technique of interrogation with a pair of electrodes in the 
manner recogimended in some writings upon electro-diagnosis. 
Diagnostic^ and therapeutic hints of great value may develop 
during the treatment of complicated cases, as we discover 
abnormal sensations and unusual effects and carefully investi- 
gate their cause by inquiry and by other methods of physical 
diagnosis. This, however, seems to me something quite apart 
from the idea of electro-diagnosis presented to the physician's 
mind by his readings of electrical reactions, quantitative and 
qualitative changes, increased or diminished excitability, the 
reaction of degeneration, and such symbols as the following : 

Ca. CI. C, An. O. C, An. CI. C, D= ^ "^ 7' ^' ^ ' 

lO'' cm. ■ 

Ka S Kl, Ka D Kl 7, Ka 0-, An O Kl, etc. 

It is, however, the only practical part of electro-diagnosis in 
clinical experience. 

An author of a work upon electro-therapeutics begins his 
chapter on electro-diagnosis by stating: " When a patient with 
" any disorder of the nervous system presents himself for 
" electrical treatment it is nearly always necessary to begin 
" with an investigation of the electrical reactions of his nerves 
" and muscles. The motor nerves and the skeletal muscles 
" should be investigated first and both the faradic and the con- 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 225 

" tinuous currents must be employed. The unipolar method 
" must be adopted and the tests must be applied to the motor 
" nerves, the muscles and the ctitaneous sensory nerves in the 
" parts affected, and they must be compared with the same 
" paryaithe sound and healthy side. To do this it is abso- 
" lutjHr essential to know thoroughly the points where the 
" ^Ve trunks are most accessible, the motor points of the 
""^Pscles, and the distribution of the cutaneous nerves." 

Such a method of examining patients seems to me difficult 
to consider in office practice, and the most careful researches 
which I have been able to make into the disclosures which 
would result from such examinations do not reveal recompenses 
for the time and trouble. The procedure is inaccurate, does 
not determine the nature or cause of the disease in important 
cases when such information is desired, and belongs to the realm 
of theoretical and experimental work rather than of practical 
therapeutics. 

An increased or diminished sensibility to a given electric 
current will often indicate a departure from the normal in the 
state of the tissues through which the current passes, but it very 
seldom discloses the diagnosis of the lesion. The nearest 
approach to exactness in electro-diagnosis is the test to deter- 
mine between a central and peripheral paralysis, but even to 
this rule there are exceptions, and the discovery of the reaction 
of degeneration does not make clear the exact cause behind it. 
This is upon the surface of the body. Within the pelvic cavity 
there are some important diagnostic suggestions derived from 
the behavior of the tissues under electric currents to which I 
shall presently refer. See chapter on paralysis for muscle tests 
between central and peripheral lesions. 

Motor Points. — How to locate motor points without a 
chart is one of the perplexities of students of medical electri- 
city which cease to trouble af^\a little practice. 

Place any ordinary sponge-oMcred flat electrode upon a 
folded towel on the knee of the parent and let him rest upon 
it the flexor surface of the forearm>a couple of inches above 
IS 



226 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER 



M & S* W W 
•|^ , * w 2 ^ ® 5J 
:g2°oSggoj„W 

g: n "S. ? S s- - " I o = 
Ifi e- F 3 g - W S? S E » 



Ulnar Nerve. 

Flexor I and IV. 

Flexor II and III. 

Fl. Dig. Prof. 
Fl. Carpi Ulnaris. 
FL Carpi Eadialis. 




Oastrocnemlus. 

SoleuB. 

.Flexor Digit. Commnnis. 



Bamiis N. Peron. Prof. > 

pro Extens. Dig. Brev. J 



luterqssei. 



Sympathetic,. 
St^rno-mastoicf,' 

Spinal Ace. Nerve. 
Sterno-mastoidj 
Phrenic Nerve. 

Deltoid. 

Musculo-^pirat Nerv 

■Triceps. 
4. Kxt. Carpi TJln. 
e. Ext. Digit. Com 
6. Ext. Dig. Min, 

(Teres M^or. 

-< Teres Minor, 

(Serratus Magnus. 

Latissimus Dorsi. 
( Obliquus Abdom. 
I (Intercostal Nerve 

'Rectus Abdom. 
TransversuS Abdom. 

Tensor Vag. Fem, 
Crural Nerve. 
Gluteus. 
Biceps. 

Vastus Externus, 



Peroneal Nerve. 

Gastrocnemius. 

Feroneus LongUs. 

Soleus. 

Extensor Digit. Com 

Tibialis Auticus. 

Ext. Halluc. Longus. 

^ Soleus. 

Ext. Halluc. Long. 

Flexor Halluc. Long 

/Extensor Digltorui 
\ Communis Brevis. 



4I0T0B POINTS OF TRUNK AND LIMBS. 

Fig. 24. 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 22/ 

the wrist. Connect this electrode with the positive pole of a 
high tension induction coil apparatus. 

Take any ordinary sponge-covered hand electrode, moisten 
it with warm water, and rub it a few times over a cake of 
soap. Connect it with the negative polo, and pass it up and 
down, and over every portion of the arm of the patient, from 
the shoulders to the finger-tips. The proper current strength 
must first be found. Switch the 800 yard No 32 coil, rapid 
vibrator, and three cells, into circuit. After contact is made 
with both electrodes, increase the current in the secondary 
circuit from zero until it produces some visible contraction 



Flexor Dig.Subl. 11 ud III. 

Dinar Kerre. 

Chraer IHg. Snbl. I and IV. 

Banna Volaris Prof. ) 

N. Ulnaris. / 

Palmarta BreTis. 

AbdHcror Dig. Min. 
Flexor Dig. Min.. 
Opponens Dig. Min 

'Lambrieales, II, ni, IV. 




Flexor Dig. Sublimis. 

Flexor Pollicla Longui., 
Median Nerve. 

Abductor Polllcis Brevll.i 
Opponens Pollicla. 
Flexor Polllcia Breris. 

Adductor PoIIIcIa.: 
Xunbricalle,!., 



wnovtor hand. 
Fig. 25. 

of muscles as the negative electrode is moved about over the 



As the labile electrode is promenaded over the surface of 
any part of the arm, or forearm, the presence of each motor 
point will be exactly demonstrated by a contraction of the 
muscles supplied. If the electrode is swept back and forth, 
the contractions will follow each other in a series of waves. 
If the electrode is steadily held upon the motor point, the 
muscles will be fixed in a tetanic contraction as long as the 
electrode is on the motor point, and the intensity of the con- 
traction will be exactly proportioned to the E. M. F. of the 
current. 



228 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONE: 

The patient can next reverse his arm, and place the exte: 
sor surface upon the stationary electrode. The operate 
need never look at any chart of electro-therapeutic anatom; 
for assistance to locate motor points. Every movement ( 
the fingers, wrist, elbow, and of the muscles acting upon then 
can be practically demonstrated on the patient, without an 
previous knowledge of charts and diagrams. 

It is a simple matter to go over the entire arm in this wai 
By placing a stationary electrode upon the back of the necl 
another electrode may be moved over the sides of the nee 
and face, and the motor points of these regions located o 
any person whenever it is desired to do so. 



Extenaor Pollfc. Brev. \ 
1— Ext. I. Interoodii). f 
FlexAr Pollicis Loogus, 



^tntcTAssens Dorsalis r. 
InterosseuB DonsUs n. 

lintcTosaens Dorsalis HI. 




Extensor lodids ProprtM. 

/Cxienoor Ballicis LoDRua.^ 
\ (— Ext. U. iDterDodU.l, 



Abductor Dig. Sliii; 
IntetosseuB IV„ 



BidK or haKs. 
Fig. 26. 

With the patient recumbent, and a positive flat electrod 
under the abdomen, a labile negative electrode may be move 
over the area of the back, and its motor points located at wil 

By turning the patient over, and putting the po.sitive ele< 
trode under the cervical spine, or sacrum, the motor point 
of the anterior trunk may be demonstrated by the labile ele( 
trode as it passes over muscles. 

By standing the patient upon a foot-plate, and prom< 
nading an electrode up and down each limb from the hip t 
the ankles, the motor points of the leg can be easily traced. 

Once witnessed, this method does away with all futur 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 229 

doubt and difficulty about the location of any motor point, 
and obviates the necessity of anatomical charts. There is 
neither pain nor discomfort to the patient, and the motor 
point can be found in less time than one could- find it in a 
chart in a book. 

The physician, however, may inquire if it is necessary to 
know where motor points are located. In practice, no phy- 
sician is compelled to either examine charts, or burden his 
mind with any attempt to remember any of these locations. 
The importance of an exact knowledge of motor points 
was immensely exaggerated by early teachers of localized 



Inferior Branch of Inferior Olateal 
Nerre— to Gluteus Maximua, 

Sciatic Nerve, 



Sleeps, short head 



Tibial Kerre., 

Peroneal Nerre. 

Gastrocnemius.. 

Soleus, 




Adductor Magtius. 
Semi-Membranosas.. 
Semi-^endinosus. 
Biceps, long head. 



Gastrocnemius. 



BACK OF LEFT LEO. 



Fig. 27. 

methods of treatment, who were proud of their skill in plac- 
ing a metalHc point electrode upon the exact spot on a pa- 
tient's body which would cause a given muscle to contract 
with a special current. This skill may have been evidence 
of their patience and industry, but it cuts a small figure in 
the practical electro-therapeutics of to-day. 

It is sufficient to know that motor points exist. They are 
wanted only once in a while. They can then be found during 
the actual treatment, without any previous investigation, and 



230 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 

as a matter of fact, the process which discovers them is the 
treatment itself, so that no other knowledge of motor points 
has any bearing on the treatment. 

The "diagnosing electrode" and the "motor point chart" 
are two things which need not trouble the general practi- 
tioner. A very large part of the work which gave motor 
points their early fame is now done in simpler ways which 
require no disrobing of the patients and no reference to a 
chart. Nine-tenths of the best work in electro-therapeutics 
is done without any practical regard for motor points, and 
when we want them, we may easily find them by the sweep 
of an electrode. 

The static machine effectually disposes of an immense 
amount of the labor formerly done by enthusiasts who tried 
to cover all applications with galvanic and faradic currents. 

Pelvic Diseases. — Owing to the general complacency with 
which an explorative laparatomy is regarded at the present 
time, by all parties concerned, except the patient, it might be 
supposed that the suggestion of any other diagnostic method 
is superfluous. It is reasonable, however, that the position 
taken by Apostoli and successfully maintained by him for so 
many years, in regard to the pre-operative study of galvanic 
reaction, should be familiar to physicians. The importance of 
the subject and the value of illustrative clinical cases justifies 
incorporating into this chapter a portion of one of Apostoli's 
own reports which should be studied by the reader. 

The important fact, which I presented to you last October, 
drawn from the post-operatory galvanic reaction based on the 
state of the uterus, properly so-called, answered this question: 
Are there fibromata on which we should operate, and which 
absolutely demand surgical intervention } 

To-day I will consider only the uterine periphery, and show 
you what galvanism tells of the adne.xa, if diseased, and to 
what degree ; if, given a cystic tumor, it is suppurative or sim- 
ply serous ; if, in a word, conservative methods may be used' 
or if a radical operation is demanded ; and, in the latter case, 
whether a vaginal or abdominal operation be preferable. 

The cases I shall give shall be the best demonstration : 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 23 1 

Case I. Resume. — Woman, twenty-nine years old, lymphatic 
and very nervous, ill five years with a double inflammation of 
the adnexa, following probably a miscarriage occurring in 1881. 
No result from the classic treatment (vesication). Partial but 
not complete amelioration by a first electrical treatment given 
from 1886 to 1887 (nine intra-uterine galvano-caustics and a 
vaginal galvano-puncture). Suspension of all treatment for 
seven years, and continuation of the same anatomical and 
symptomatic situation. In July, 1894, verification of a tumor 
of the adnexa, painful to the touch and quite hard, filling the 
Douglas cul-de-sac. Is it suppurative, inflammatory, or simply 
cystic ? The diagnostic point elucidated by the galvanic treat- 
ment, from the 29th September to 24th November, 1894, six- 
teen positive intra-uterine galvano-caustics, varying from 50 to 
go ma., and finally one single negative intra-uterine galvano- 
caustic, at 70 ma., neither febrile reaction after the operation 
nor marked symptomatic amelioration. Laparotomy obligatory. 
Confirmation of the galvanic diagnosis before the operation. 
Cystic tumor serous, large, from the right tube, without traces 
of suppuration or recent inflammation of the adnexa. 

Diagnosis. — I was called in consultation the 29th November, 
1886, and I discovered inflammation in both adnexa, more aciite 
to the right, with very marked infiltration in the Douglas cul- 
de-sac. 

First Electrical Treatment. — From tl\e nth December, 1886, 
to 2 1st February, 1887, I appUed nine negative intra-uterine 
galvano-caustics, small dose, averaging 20 to 30 ma., and for 
five minutes each time. All these treatments, made at the 
house of the patient, who was in bed, were generally well tol- 
erated, and were not followed by any very marked post-opera- 
tory reaction. On the 25th February, 1887, a complementary 
negative galvano-puncture was made in the Douglas cul-de-sac, 
under chloroform, a fiUiform trocar being introduced several 
millimetres, in the centre, at the seat of inflammation lying in 
the Douglas cul-de-sac, and to the right. All these electrical 
operations, in which there were no unpleasant incidents, were 
followed by a partial recovery, which unhappily was not com- 
plete, on account of the interruption of the treatment caused 
by her departure from Paris. From this moment all active 
treatment was suspended during the seven years which she 
was not in Paris, and the frequent news which she wrote me from 
time to time showed that her physical condition remained 
about the same. Always the same pains, the same weakness 
when walking, almost constantly in bed fourteen days in the 
month, and the same alternacy of crises followed by rare peri- 
ods of remission. The only symptomatic change which followed 



232 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 

the galvanic puncture, and which was durable was the disap- 
pearance of pain the moment the menstruation commenced. 
This was the time that she felt the best, especially before the 
menstruating, when an amelioration set in to end with the 
menses. 

Then she decided to return to consult me, and to complete 
the treatment which had been interrupted seven years ago. 

Actual State, lyth July, 18^/f.. — For three months she suf- 
fered more on the right side, to which were added lumbar 
pains. Sometimes, more rarely, she suffered in the left side. 
She complained at the same time of heartburn, nausea, of me- 
grim, and of very frequent headaches, and felt a pain in the 
right hypogastrium, " an engorgement," she called it, with a 
weight at the rectum, to which she, being very constipated, 
attributed all her trouble ; besides she is very nervous, ex- 
cessively impressionable, without, however, having hysterical 
crises. 

Diagnosis. — Large uterus with an anteflexion and a right 
latoro-version. A hard tumor in the adnexa, painful on exam- 
ination, large, and adherent posteriorly. The uterus being 
pushed to the right, this tumor seemed to leave the left cul-de- 
sac and fill the Douglas cul-de-sac entirely, being lost behind 
the uterus in front of the sacrum. 

This tumor is characterized, first by its large spherical de- 
velopment, then by its marked tenderness, and, finally, by its 
hardness in some places, while at others it scarcely felt like a 
solid tumor. 

Undoubtedly it is a tumor of the adnexa, concerning which 
many important questions arise. Is it suppurative, inflamma- 
tory, or simply cystic ? The answer to this question should 
determine the choice of treatment (conservative or surgical), 
and in the case of a radical operation, ought to decide abso- 
lutely for or against the vaginal or abdominal method. I saw 
at once, considering the history of the case, that probably only 
a radical operation would be effective ; the necessity for it, 
however, not being immediate, I decided, on the formal invi- 
tation of the patient, to make a second electrical trial before 
abandoning all hope of conservation, and, though I was per- 
suaded in advance of the probable futility, we would gain 
valuable data to establish the diagnosis. 

Second Electrical Treatment. — The first, intra-uterine, gal- 
vano-caustic, + 4° ma., five minutes, on July 26, 1894, had no 
reaction except a little lassitude in the lower abdomen. The 
night and the day following were good, except for a little 
pain in the left side accorppanying rising and sitting; the 
patient had just menstruated, and afterward was always better. 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 233 

The second and third treatments, 50 ma. -|-, on the 28th and 
31st July, were followed by no appreciable reaction. The 
patient went to the country on a vacation, and returned to the 
clinic September 29, 1894. During this absence of two months 
nothing particular happened. She complained always of her 
right side ; the excitement of the return and of the tentative 
operation caused an intense migrane with repeated bilious 
vomiting, lasting forty-eight hours. She had already had two 
similar attacks, two and three years before, but they were less 
severe, and later she had another, quite intractable for three 
days, because a patient whose bed was next to hers was chloro- 
formed. Sixteen more intra-uterine treatments (50, 70, 70, 90, 
80, 60, 60, 50, 50, 40, 60, 50, 40, 35, 50, 40 ma.), usually of five 
minutes duration, were made about three times a week from 
September 29 to November 24, 1894; there was neither an 
intense operatory nor post-operatory reaction. The symptoms 
of the patient were not modified by the treatment ; the same 
sickness persisted, making locomotion very difificult, with oc- 
casional intermission of varying intensity. Appetite good, 
but pain considerable at the right, though it did not disturb 
her sleep. Finally, on November 29, in order to demonstrate 
the absence of inflammation and of suppuration in the adnexa, 
and in order to study better the character of the post-operatory 
reaction, if one could be produced, we gave her for the first 
time — treatment 70 ma. for five minutes, the sound being 
pushed to the fundus. Although w'ell tolerated, the stance 
was followed that night and the next day by pain in the entire 
abdomen, which felt, she said, like a tearing out of the abdo- 
men and kidneys. There was, however, no fever nor anorexia ; 
in a word, no manifestation of acute inflammation. 

The only result was to advance by six days the menstrua- 
tion, which was due the loth of December, not surprising after 
a negative intra-uterine application. 

The local electrical treatment being unsuccessful, from a 
symptomatic point of view, and having thus acquired a knowl- 
edge that I would not find a suppurating ovaro-salpingitis, I 
decided on an operation. 

Report of the operation made by Dr. Le Bee, January 10, 18^5. 
— On opening the peritoneum, adhesions of the omentum 
could be seen. The right tube did not seem very large, the 
left did not appear to be affected. Lace-like adhesions bound 
the intestine and had to be destroyed before they could be 
raised. 

a. Left side. — Numerous adhesions between the intestine 
and the left tube. The left tube and ovary were abnormally 
high, the fimbriated extremity being fixed to the sacro-vertebral 



234 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 

synchondrosis by a fibrous band. No tumor of the tube, which 
appeared to be only catarrhal, though the ovary contained 
small cysts. No pus. 

b. Right side. — The right tube distended, resembling a thin 
intestine, had its fimbriae extending into the Douglas cul-de-sac, 
where it was fixed by easily broken adhesions. The ovary, 
which was intact, was also fixed by numerous adhesions to the 
uterine wall. The utero-ovarian ligament was much shortened. 
Finally, there were slight adhesions between the anterior and 
posterior walls of the uterus and the proximate organs, which 
could be readily broken with the fingers. The right tube, 
twelve centimetres long and ten in circumference, looked like 
a large sausage. It was filled with a transparent fluid which 
made it look like a vaginal hydrocele. 

Conclusion. — Here, then, is an instructive case where the 
galvanic diagnosis has been confirmed by a subsequent laparot- 
omy. The galvanic indications were very clear, stating that 
there was neither pus nor recent inflammatory processes, and, 
in fact, we have found no trace of a recent inflammation of the 
adnexa, and the cystic fluid in the tube was absolutely serous 
and transparent, without a trace of either local or peripheral 
suppuration. The many adhesions found were old, and not 
connected with any actual inflammatory process. This same 
pre-operatory behavior with galvanism ought in the future to 
affect our operations and, if not to stop them, at least to advise 
us to perform one less radical. Thus in a case of a non-sup- 
purating tumor, projecting into the Douglas cul-de-sac, a simple 
incision in the posterior cul-de-sac, with the evacuation of the 
hydro-salpinx, would sulifice to cure without the irremedial 
mutilation of the woman. In the case of a final failure, a 
second more radical operation could be made. 

Case II. (resume'). Woman of twenty-eight, with small, 
very hemorrhagic fibroid. Treatments from February, 1892, 
to September, 1894 — fifty-one in all, intra-uterine galvano- 
caustic, usually with large dose. Symptomatic success at first ; 
later, failure. Absence of marked post-operatory reaction, and 
the integrity of the adnexa demonstrated by this galvanic 
treatment. Final malignant degeneration of cervix. Same 
intra-uterine galvanic tolerance preserved. Abdominal hys- 
terectomy. No trace of lesion of adnexa, and confirmation of 
the pre-operatory diagnosis. 

Mme. L., aet. forty-eight, washwoman ; one child, twenty 
seven years old. January 30, 1892, sent to Dr. Apostoli's 
clinic by Dr. Gernard ; had been ill for some years. The 
symptoms were as follows : 

Actual symptoms. — i. Continuous abdominal pain, especially 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 235 

on the right side, and extending into the rectal region. They 
are augmented by the least fatigue. (Began fifteen to eight- 
een months ago.) 2. Menorrhagia for four months, lasting 
ten to twelve days, confining the patient to her bed because 
of the quantity, but painless. 3. Much leucorrhoea, which had 
lasted for a long time. 

Diagnosis. — On examination, a retro-placed uterus was found 
with an iriterstitial subperitoneal fibroid as large as a small 
orange, which hung down the posterior wall and resembled a 
retroflexion. No inflammation of the adnexa. Depth 8;^ cen- 
timeters. 

The treatment, commencing February 4, 1892, can be divided 
into three periods, separated by different intervals. 

First period. — Until the 13th of August, 1893. From the 
beginning six + intra-uterine galvanic treatments, five minutes 
each time, the doses being 50, 120, 165, 100, 75, 100 ma. It 
was always well tolerated, and without too much post-operatory 
reaction. 

Then twenty-eight intra-uterine applications of the alternat- 
ing sinusoidal current were given. The result, as far as the 
pain and leucorrhoea was concerned, was favorable, but did not 
still the hemorrhage, probably on account of the insufficient 
hemostatic action of the alternating current. Two menor- 
rhagias occurred during the two months when the treatment 
was interrupted (August and September), but in spite of that, 
the general condition of the patient was sensibly improved 
(better appearance, more strength, and could walk better). 

Second period. — The treatment was recommenced October 
13, 1892, + galvanism 140 ma., five minutes, which was well 
borne and without painful post-operatory reaction. Then 
from the 20th of October to December 13, six alternating 
treatments. Finally, the hemorrhage and leucorrhoea having 
returned, galvanism was resumed. From December 15 to 
July 13, 1893, -(- galvanism was given twenty-nine times. 
Dose 14s, 170, 100, 150, 140, 165, 80, 125, 150, 140, 150, 150, 
140, 150, 135, 13s, 145. 140, 145. 120, 130, 125, I2S, 130, 130, 
130, no, 145, 60, 100 ma. Five minutes on an average. 

As usual, I kept a complete record, and no evidence of either 
painful or febrile post-operatory reaction was shown. Treat- 
ments were three times a week, or every other day. 

This treatment helped the hemorrhage, though slowly ; 
menses were regular or late, and less abundant, and in July, 
1893, they were delayed thirteen days, which had never before 
occurred with her. The general health was fair, locomotion 
easier, sleep good, and the anterior pain seemed to have disap- 



236 ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 

peared ; nevertheless a slight flow, leuchorrhoea, or hydrorrhea, 
persisted. 

A phlebitis, which confined the patient to bed for six weeks, 
interrupted the treatment for three and one-half months. 

The amelioration of the hemorrhage lasted two months after 
the last treatment (July and August), the menses being normal. 
But by October the menorrhagia was marked. 

Third period.— Fatient returned to the clinic in November, 
1893. The tumor had not increased in size. The anatomical 
situation appeared to be the same, probably without phleg- 
masia of the adnexa. 

Then ten treatments were given, from November 2, 1893, to 
January 11, 1894. The doses being 100, ipo, no, 100, no, 
140, 85, 105, no, 100 ma., for five minutes. No marked re- 
action. The hemorrhage continued and a new symptom ap- 
peared. A gray, watery discharge, mixed with pus, and having 
a foul odor. 

As the menorrhagia relapsed so frequently, the intra-uterine 
treatment seemed ineffectual, and as the tumor was readily 
accessible, galvano-puncture was tried. 

A new gold trocar, insulated to a few millimetres from the 
end, permits through its insulation, a large quantity, without 
much pain or scarring of the vagina, and avoids all danger of 
a subsequent septicaemia. 

On January 30 and May 8, 1894, -f- galvano-punctures were 
made without anaesthesia, 100 and 140 ma. being given. 
Though they were well supported they did not seem to benefit 
the patient. Then uterine treatment was' suspended for two 
months, and the improvement of the depressed general health 
was attempted by means of baths with rapidly alternating 
currents. 

But the persistence of the hydrorrhea necessitated the re- 
sumption of the galvanism. Renal pain, extending to the 
sides of the abdomen, had returned. September 18, forty- 
seventh -\- galvanic treatment, 70 ma., five minutes, well sup- 
ported. September 20, 22, 25, and 27, 100, no, 180, 200 ma. 
were given respectively. All well supported. 

All the operations had been well borne and without marked 
post-operatory reaction, though the sound was always 7-8 cm. 
in the uterus, but there were no results. A last examination, 
on December 23, 1894, confirmed the fears I had had for a 
year. 

The final failure of intra-uterine galvanism patiently given, 
and well borne, as well as the appearance of an abundant' and 
fetid hydrorrhea, had made me suspect a malignant degenera- 
tion, which was slow to show itself externally. 



ELECTRO-DIAGNOSIS FOR THE GENERAL PRACTITIONER. 237 

But by the end of December a false diagnosis was impossi- 
ble. I at once advised her to be operated upon, and on the' 
loth of January Dr. Le Bee performed an abdominal hyster- 
ectomy. 

Report of the Operation. — I found a large fibroid growing 
from the fundus : a smaller one was found at the left. 

Numerous adhesions bound the mesentery and even the 
intestine to the tumor. The adnexa were high, and pushed 
back. I made a total extirpation by the method I had adopted. 

Examination of Tumor. — Adhesions, which show no signs 
of inflammation. The cancer limited to the cervix, extending 
to the internal os, but not above. The "cervical canal dilated, 
its walls degenerated. The uterine body enlarged by a fibroma, 
growing posteriorly, and interstitial tumors which show micro- 
scopically all the characters of the classical fibroid, without any 
signs of degeneration. The adnexa normal, without signs of 
recent or old inflammatory processes. 

Conclusions. — The bimanual examination showed a woman 
without inflammation of the adnexa. The only manifest lesion 
was a fibroid, apparently simple. But we know that laparot- 
omies frequently reveal the inadequacy of bimanual examina- 
tion. Therefore I have sought in the electrical application a 
more certain method of diagnosis, and I think it has the pre- 
cedence of the bimanual examination. Here the two methods 
agreed in stating that there was no inflammation of the adnexa. 
This was substantiated by the laparotomy, and shows the im- 
portance I give to value of the testimony of galvanism, applied 
patiently, methodically, and wisely. But, in the last year, the 
galvanism acquired a further interest, from the degeneration 
of the cervix, with the conservation of the integrity of the 
uterine body. The progressive cachexia caused by the malig- 
nant degeneration could, a priori, be expected to stop the 
treatment. Actually it did not do so, and this case shows 'us 
what we already know, that the condition of the adnexa partly 
regulates the galvanic tolerance, and further, that this toler- 
ance is not directly influenced by the localized degeneration of 
the cervix, though the contrary is true in the degeneration of 
the entire body, as I demonstrated to you last October. 



CHAPTER XV. 

TREATMENT OF PELVIC DISEASES. 

Chief clinical methods. Percutaneous galvanism. Vaginal bipolar faradization. 
The technique of bipolar sedation. Duration and frequency of treatment. 
Vaginal bipolar stimulation. Clinical hints. Intra-uterine bipolar applica- 
tions. Massage and electricity in gynecology. Faradic apparatus for pelvic 
practice. Galvanic precautions. How to regulate galvanic dosage with 
large currents. Aids to the diagnosis of pelvic lesions. Indications for elec- 
tricity in gynecology. Intra-uterine " cauterization." 

The major part of Gynecological electro-therapeutics in- 
volves .skill in the .selection, management, manipulation, and 
modification of but Four Chief Methods of employing cur- 
rents. 

1. External method, the percutaneous administration of a 
galvanic current through the pelvis. 

2. Vaginal faradic method (bipolar faradization). 

3. Galvanic currents employed with one electrode in the 
vagina and the other externally. 

4. Galvanic currents employed with one electrode in the 
uterus and the other externally. 

The teachings of the electro-physiology of galvanic and im- 
proved induction coil currents, together with clinical experience, 
have rendered the choice of these methods and the selection of 
poles and regulation of dose, a simple and fairly exact matter. 

In addition to these four leading methods of practice the 

faradic current is sometimes applied with one electrode in either 

the vagina or uterus, and one externally on the abdomen or 

lower spine, and metallic electrolysis is also superimposed upon 

galvanic current action — but the physician who can adapt these 

four methods to functional derangements or pathological states 

may be said to command nearly all the aid that medical elec- 

238 



TREATMENT OF PELVIC DISEASES. 239 

tricity can furnish to medical and surgical gynecology by local 
applications. 

Beyond these local methods there are also general benefits 
to be derived from a well handled static machine, and beyond 
these are the surgical uses of electro-cautery. The experi- 
mental stage of methods of treatment has passed, and experience 
has amply demonstrated that no practitioner can afford to 
dispense with the help of medical electricity in the routine 
treatment of the diseases of women. 

Owing to the elaborate terminology of pelvic affections the 
list of lesions treatable by electricity in all its forms seems a 
long one to the physician who has been familiar with the action 
of any one current alone. Moreover the general custom of 
referring to indications and applications in an indefinite manner 
has left the practitioner in doubt as to the form of current, 
polarity, electrodes, dosage, and other essential particulars, so 
that gynecological electro-therapeutics has appeared to many 
to be as delusive as the mirage of the desert — a vague, difficult, 
whimsically mixed uncertainty of doubtful methods, with 
nothing but a trail of guesswork to guide the operator to 
results. 

Such was the state of affairs in 1885, but it does not apply to 
1897. As a matter of fact gynecology not only constitutes the 
most useful local field of electro-therapeutics, but the apparatus 
required and the exact work each type of current will perform 
within the pelvis is more definitely mapped out, understood, 
and applied, than in any other branch of medical electricity. 

When, however, at the beginning of his experience the choice 
of one of the four chief methods of employing direct and in- 
duced currents for the relief of pelvic symptoms or disease, 
cannot be made at sight by the physician he can often solve 
the problem of treatment as he sometimes solves the problem 
of diagnosis — by exclusion. 

He will rarely make a mistake if he initiates treatment with 
either bipolar vaginal sedation, or the sedative-tonic action of 
percutaneous galvanism in cases in which pain and tenderness 



240 TREATMENT OF PELVIC DISEASES. 

are marked symptoms. These two methods possess great value 
with practically no possibilities of harm, and are always avail- 
able at the first visit of the patient. 

During the period of a woman's functional activity she is 
liable to pelvic diseases which circumstances make it hard to 
cure, and relapses which it is hard to prevent. It is as injudi- 
cious to rely upon electricity alone in the treatment of these 
difficult affections as it would be preposterous to rely upon any 
other single agent, however valuable. Electricity has, however, 
demonstrated its title to rank first among conservative remedies 
— with no other agent of its class in sight. 

During the ten years between 1884 and 1894 the practical 
possibilities and reliable utility of galvanic and fine induction 
coil currents were very fully developed by clinicians of unrivalled 
experience, at the head of whom stands the honored Apostoli ; 
so that for several years past the status of these currents has 
been fully established for general recognition and employ- 
ment. 

Methods of technique are no longer in a nascent state of 
change, but have become more definitely determined than the 
accuracy of diagnosticians. Electricity has demonstrated its 
physiological and therapeutic actions, and now stands ready to 
be employed. Many of the problems of the transition period 
of gynecological electro-therapeutics have been substantially 
settled since the first years during which improved induction 
coil apparatus were made available and the correct dosage of 
galvanic currents ascertained. In the chapters that follow I 
describe each application with full and explicit detail, and have 
presented a great variety of different clinical conditions so that 
the physician can turn to these pages for practical help in the 
treatment of his own cases. 

Topical Routines of Gynecology. — Some of the procedures 
which have been, and still are, recommended for pelvic con- 
ditions especially amenable to proper electro-therapeutics are 
medical crudities if not actual barbarism. The best gynecolo- 
gical methods of employing electric currents supplant a large 



TREATMENT OF PELVIC DISEASES. 24I 

part of time-honored and unsatisfactory measures. No one 
who is familiar with the practical utility of the half dozen 
electrical methods which successfully relieve a great percentage 
of the ordinary diseases of women can fail to wonder at many 
of the inferior methods of practice retained to the exclusion of 
electricity in the routines of gynecologists. 

I hold very decidedly to the view that no physician or surgeon 
who assumes to treat the diseases of women can do his patients 
justice without the help of electricity. No careful operator for 
instance, can afford to remain unacquainted with such a simple 
and valuable therapeutic method as bipolar faradization. If 
compelled to choose between the efficient remedy thus supplied 
by a single vaginal bipolar electrode and a high tension induc- 
tion coil apparatus, and ordinary resources of local medication, 
ointments, suppositories, pencils, solutions, iodine, and pessa- 
ries, and a considerable number of minor surgical operations, I 
would deem it a lucky trade to swap them for the battery and 
the electrode. 

Both induction coil and galvanic currents are remedies of 
very great practical value, and are within comparatively easy 
reach not only of the specialist but of the general practitioner 
who will give the matter reasonable study. 

Having attained a practical settlement of disputed questions 
of apparatus and technique, and progressed out of the experi- 
mental stage of electro-therapeutics it is ■ certain that no 
inteUigent physician, no graduate of any reputable medical 
college, no practitioner who strives faithfully to secure the 
best clinical results, can now fail to give his patients the benefit 
of the splendid capabilities of electric currents in the treatment 
of pelvic diseases. Their great value cannot be ignored. The 
. benefits which can be produced by the simple methods described 
in this book speak for themselves whenever they are witnessed. 
In many cases the patient is promptly relieved without incon- 
venience, confinement in bed, or troublesome restrictions upon 
her daily habits, when in similar cases other remedies and 

methods of treatment supported by eminent authorities are 
16 



242 TREATMENT OF PELVIC DISEASES. 

irksome, full of trouble, often associated with suffering, and 
end in unsatisfactory results. 

I do not see how a physician can reconcile himself to the 
neglect of means which will successfully relieve ninety out of 
every hundred cases of ordinary dysmenorrhea. 

I do not see how a physician can fail to seek the means of 
relieving almost all the forms of pain which spring from de- 
rangements within the pelvis like the manifold miseries out of 
Pandora's box. 

I do not see how any one who consults his own professional 
interests can neglect the chief remedy against endometritis 
and the majority of its accompanying evils. 

An electric current which will almost infallibly conquer sub- 
involution and chronic metritis is valuable. The means of 
restoring strength to weakened supports of the uterus, of cor- 
recting recent displacements and removing the effects of 
chronic alterations is a practical boon to patients. 

And so we might go on, omitting all that can be said of the 
uses of electric currents in rare and grave lesions, and confin- 
ing our remarks to cases in every day practice,- — cases of func- 
tional neuroses, of pain, congestion, inflammation, hemor- 
rhagic conditions, amenorrhea, versions and flexions, subinvo- 
lution, prolapsus, minor lacerations, and atonic states, with 
associated anemias, neurasthenias, dyspepsias, headaches, back- 
aches, and the wide range of symptomatology which suffering 
womankind presents, — we find that in galvanic, high tension 
induction coil, and static currents we often possess the most 
practical means of relief within the domain of medicine. If 
these electric currents possessed no other power than their 
demonstrated ability to improve nutrition, dislodge pain, con- 
trol hemorrhage and afford prompt, grateful, and lasting 
symptomatic relief in a score of obstinate pathological condi- 
tions we should say they wereindispensable in office practice. 

I am convinced that they are indispensable. Treatment of 
the diseases of women without the aid of improved electrical 
apparatus is not satisfactory treatment either to patient or 



TREATMENT OF PELVIC DISEASES. 243 

physician. Leave electricity out of gynecology and we have 
the play of Hamlet with Hamlet left out. It is only when 
general and local prescribing and electrical currents join 
friendly hands and supplement each other that the best clini- 
cal results are attained. 

External Galvanic Method. '< Percutaneous Galvanism." 
This constitutes a general sedative-tonic, nutritional and alter- 
ative treatment for the pelvic viscera in ansemic and neu- 
rasthenic cases, especially with vague general pains and de- 
rangements of menstruation. It is extremely agreeable to 
patients and has a powerful tonic action. 




Fig. 28. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

Place the patient in the usual dorsal position upon the 
operating table. Select two similar felt-covered electrodes of 
medium or large size (6 X 8, or 7 X 9). Saturate them in a 
two per cent, solution of soda-bicarbonate as hot as they can 
be handled, and press them sufficiently dry to prevent wetting 
the patient's clothes. These electrodes should never be 
pressed as dry as possible, but must be allowed to retain the 
maximum amount of moisture short of dripping. 

Place one of these electrodes under the lumbo-sacral spine, 
where it will be kept in close contact with the tissues by the 
pressure of the patient upon it. The electrode is backed with 
rubber, but pressure will spread the moisture of the felt out of 
the electrode at all sides, and the protection of a thickly 



244 TREATMENT OF PELVIC DISEASES. 

folded towel should be placed between it and the patient's 
clothing. 

Place the other electrode across the lower abdomen, and 
the firm contact which is absolutely necessary may be main- 
tained by the weight of a small bag containing sand or shot, 
or the patient may be requested to press the broad palms of 
her hands upon the pad to hold it firmly down. 

Connect the posterior electrode with the positive pole and 
the anterior electrode with the negative, in the absence of 
special indications for the reverse. 

Increase the constant galvanic current gradually from 2ero 
up to 20 mil. In five minutes again increase the current to 
about 30 mil. This should be perfectly comfortable to the 
patient. Never cause a burning sensation that is annoying. 
If a mild current causes burning examine the skin, and if any 
abrasion or eruptive state is found to account for the irrita- 
tion protect the spot with a piece of adhesive plaster to in- 
sulate it. 

Hold the maximum current strength for about ten minutes, 
and reduce slowly to 20 mil. In three minutes more reduce 
the current gradually to zero. 

Without disturbing the electrodes switch the automatic 
rheotome into circuit, regulated to about 100 interruptions 
per minute. Again increase the current strength from zero 
up to the point of producing moderately strong, but entirely 
agreeable, pulsations through the parts. In from three to 
five minutes reduce the current to zero, remove the electrodes, 
dry the surface of the skin with a soft towel and dust with 
toilet powder — a very grateful finish to the stance in private 
practice. 

If the abdomen is tender, and pelvic congestion exists in- 
stead of anaemia, reverse the polarity and place the positive 
electrode over the abdomen. If any condition is present which 
contra-indicates the tonic muscular contractions caused by the 
interrupted current, they may be omitted and the sitting limited 
to the constant current alone. 



TREATMENT OF PELVIC DISEASES. 245 

This method is useful in the treatment of unmarried women 
and of other patients in which definite indications for intra- 
pelvic electirodes are not clearly presented to the practitioner 
at the first visit without further study of the case. It is there- 
fore exceedingly valuable as an introductory treatment, es- 
pecially with patients who have been somewhat timid and 
fearful that they will be hurt. Its soothing and tranquillizing 
effects upon the nervous system and the mind would be sufifi- 
cient to establish its value as a splendid therapeutic measure 
if it contributed very little benefit of other kinds. 

It is also a useful intercurrent alterative tonic, when intra- 
uterine applications are only made at intervals of six or ten 
days. 

In a case with troublesome symptoms and yet no pro- 
nounced pathology to account for them it is one of the best 
methods by which to begin the treatment, and continue it 
until indications are determined for more exact localization of 
method. It possesses the still further advantage that it is ad- 
missible and is acceptable to the patient in the class of cases 
who are unwell pretty near all the time, and who are sadly 
in need of treatment but are reluctant to attend until they 
stop oozing. 

Percutaneous applications are usually repeated three times a 
week, although they may be administered daily with benefit 
during the first week of treatment if the patient consents 
and if speedy effects are desired. Their interesting possibili- 
ties in general bleeding states are illustrated by the following 
case : 



January 17, 1894, Mrs. , age 26, married six years; no 

children ; menstruated at 13. Regular until two months ago ; 
then noticed a continuous show of blood, increasing during 
the last fortnight into decided hemorrhage, with severe back- 
ache. She presented the appearance of grave disease and ad- 
vanced age ; was in a state of complete mental and physical 
prostration, crying and frightened, and as hypersesthetic as if 
she was in the agonies of acute strychnine poisoning. She 



246 TREATMENT OF PELVIC DISEASES. 

had just been bluntly told by a doctor on whom she called 
that "she had a cancer, and unless she, had it cut out at once 
she would not be alive in three weeks." The horrible in- 
formation threw her into a state of collapse, and an examina- 
tion was out of the question. Fortunately, the tonic and 
sedative influence of static electricity may be availed of with- 
out touching the patient or removing any garments. After a 
soothing application and encouraging advice, she went home 
free from pain, slept restfuUy and regained composure. An 
internal examination was purposely avoided, while she was 
diverted from thoughts of cancer and told that it would be 
time enough in a month or so to find out what was the matter 
with her. Bovinine was added to her nourishment, and her 
electrical treatment directed to relieving the backache, im- 
proving nutrition and nerve tone and reducing the hemor- 
rhage. Daily static electrization was given for fifteen minutes, 
and percutaneous, lumbo-abdominal applications of 20 to 40 
mil. constant current were administered by my able associate. 
Dr. Fannie W. Oakey, who assumed charge of the case. On 
the fifth day the hemorrhage was entirely under control, the 
backache had yielded, as backaches always do, to the mild 
static spark, and, although an alarm of fire occurred in her 
home on the 23d, and caused a temporary aggravation of 
symptoms, she made such steady progress as to raise her 
hopes that the idea of cancer was a mistake. January 29, 
record reads: "No oozing; has slight backache late in even- 
ing if fatigued during the day, but it leaves on going to bed ; 
all other symptoms are removed ; she sleeps well and feels 
fine." On the 31st she had some uterine oozing of blood for 
a single day. February 15, after 11 treatments since January 
22 (sixteen in all), she became unwell. On the 19th she re- 
ported : " Menses about normal this time ; best period in four 
months ; three days' regular flow, drying up naturally on the 
fourth day. Had some pain, but have always had it when 
menstruating." Five more treatments carried her up to 
March 7, when color had returned to her face, and she felt and 
seemed, to all appearances, in good condition to be examined 
and know the worst. 

A microscopic examination confirmed a diagnosis of epith- 
elioma of the cervix. Her husband was at once informed of 
the diagnosis and advised to arrange an early operation, and 
electrical treatment was stopped. I never saw her again. 
The operation, performed in one of the hospitals of New 
York, proved fatal. Under the circumstances of her peculiar 
case, I do not know what other agencies could have been 
employed to equal the comfort or surpass the benefit she 



TREATMENT OF PELVIC DISEASES. 



247 



derived from the application of electricity, by only general 
methods, during the month which prepared her so well for — 
death. 



There are other useful services performed for patients by 
this simple method which will be noted in the succeeding 
chapters. By skilful dose regulation all the way from 10 mil. 
up to 100 mil. the effects may be varied to suit the object 
aimed at. 

Vaginal Bipolar Faradization. — In instructing physicians in 
practical electro-therapeutics I have been accustomed to point 
out the remarkable attributes of the vaginal bipolar electrode, 
and the useful services it renders. 

Few are aware of its great value. References to its use are 




Fig. 29. A proper bipolar electrode. 




Fig. 30. An improper bipolar electrode. 



obscured amid the generalities of electro-medical writings, but 
it deserves a special prominence, for it is the gem of distinctly 
faradic electrodes, and is the means of securing unique and 
precious effects within the pelvis. Through its development 
and the improvement of high-tension induction coil apparatus 
faradic currents reach the high-water mark of their utility in 
gynecological practice. It is a comfort alike to patient and 
physician, for it involves no unfastening or removal of gar 



248 TREATMENT OF PELVIC DISEASES. 

merits, no wet pad upon the skin, no " getting ready," and no 
demand upon special instrumental skill. 

The general practitioner can, with the very simple care and 
knowledge which is requisite, employ it as satisfactorily as the 
most eminent gynecologist, and an appreciation of its services 
grows constantly with use. 

The bipolar method must never be employed with the cur- 
rent from any faradic battery possessing the coarse spring vi- 
brator found upon all ordinary apparatus. It must never be 
employed with the crudely constructed coils which are fur- 
nished with about all the faradic batteries which cost from thirty 
down to two dollars and a half, and the injurious effects which 
may be produced in inflammatory cases with an improper coil 
are even less important to consider than the effects of the 
irregular, jerky, and rasping, irritating interruptions caused by 
the coarse vibrator in general use. 

The electrode itself must be properly proportioned and light 
in weight, and all others must be discarded. Both the elec- 
trode and the current must be suited to the therapeutic work 
in hand, and refined results cannot be expected from coarse 
and non-therapeutic apparatus. Compromise is absolutely im- 
possible in this field of work. The apparatus must either be 
the best obtainable, or it must not be used at all. There is no 
middle ground. 

The beautiful resources of the bipolar method unfold them- 
selves exquisitely in electro-physiological studies. Every va- 
riation in the current, the coil, and the rate and character of 
interruption lends variety to their manifold effects. Just as, 
in hydro-therapy the applications of water in different doses 
of temperature, rate, and volume produce different or opposite 
effects, so in electro-therapeutics the variability of dosage 
gives us control of a wide range of effects upon the circulatory, 
nervous, and muscular tissues of the pelvic cavity. 

Among the clinical effects within the compass of vaginal 
bipolar faradization are the sedation of irritable or painful 
states ; the relief of congestion and inflamhiation ; increase 



TREATMENT OF PELVIC DISEASES. 249 

of metabolism and nutrition ; absorptive tissue changes with 
marked tonic effects upon the capillary and lymphatic cir- 
culation ; and a general muscle, nerve and circulatory stim- 
ulation throughout all the organs influenced by the current. 
Pain of many varieties may be relieved, recent exudates may 
be absorbed, relaxed supports of the uterus may be toned up, 
congested ovaries and vessels maybe relieved of their engorg- 
ment, deficient vaginal secretion may be restored, tenderness 
and spasm removed, and the symptomatic burdens of func- 
tional and mechanical derangements and non-suppurative path- 
ological lesions may often be lightened wonderfully by this 
method alone, and especially when reinforced by galvanic cur- 
rent actions. 

As an auxiliary to other measures it is also often invaluable 
when lesions are beyond its direct reach. Some of the phases 
of galvanic current action, which are indefinitely called catalytic, 
are present in these coil currents, and aid in the happy results 
produced. 

The gradations of these results are given extreme range by 
adroit technique. The most directly opposite effects may be 
called in their narrowest sense sedation and stimulation, but 
along with these go delicate shadings of method which give 
the physician control, either partial or complete, over many of 
the states which bring sufTering women to his office. 

The Technique of Bipolar Sedation. — Place the patient 
upon the operating table in the usual dorsal position, with feet 
drawn up and knees apart, as for an ordinary digital examina- 
tion. No speculum is employed, and no antiseptic irrigation 
of the vagina is necessary. Warm the bipolar electrode to 
about blood heat (generally by holding it enclosed in the palm 
of the hand while connecting the battery), lubricate the tip 
with plain vaseline, attach ^^ positive coxA to the tip end, and 
the negative cord to the inner half. Each maker indicates by 
some special mark the separate sides to which to attach the 
positive and negative cords. Always have the rectum emp- 
tied first. 



250 TREATMENT OF PELVIC PISEASES. 

Insert the electrode gently behind the uterus, and well up 
in the cul-de-sac as far as it will go without forcible pressure. 
Support it steadily during the seance, so that no muscular 
contraction or movement of the patient will cause it to slip 
out, but be careful to avoid pressing the thigh muscles. The 
tissues within the caivity are insensitive to induction currents, 
but the tissues of the vulva are as sensitive to the same currents 
as is the eye to a cinder. Have the electrode well inserted be- 
fore any current is started, stop the current before the electrode 
is withdrawn, and never let an electrode bring a faradic cur- 
rent in contact with the tissues of the vulva. One experience 
with the agony caused by such an accident would lose the con- 
fidence of the patient forever. 

Switch four or .five cells, the rapid vibrator, and the 1,500- 
yard No. 36 coil in the circuit, with the current at zero. 
Gently increase the dose by means of the rheostat until the 




Fig. 31. Bi-polar Vaginal Electrode. 

patient feels the current perceptibly. Again evenly and grad- 
ually increase it to the point of producing a firm and comfort- 
ing grasp upon the tissues. It is important to reach the max- 
imum of current strength required for the effect, and neither 
go beyond it nor fall short. With a little experience the reg- 
ulation to the point of exactness is very simple, but the be- 
ginner can only be instructed by practice. 

If in attempting to reach full tolerance a little pain is caused, 
reduce the current instantly until pain ceases. Direct the pos- 
itive tip of the electrode next against each painful point that 
can be detected by carefully shifting it from one ovarian re- 
gion to the other. Regulate the dose to full comfortable tol- 
erance, and hold the tip steadily upon the point of tenderness 
until it is relieved. (This will require perhaps five minutes or 



TREATMENT OF PELVIC DISEASES. 25I 

less. If more than one such point is found, the treatment is 
the same for all). 

As sedation increases with each moment of the action of 
the current the original maximum dose will soon be felt less 
strongly, or may cease to be felt at all in five or ten minutes. 
Gently increase the dose again until it reaches the maximum 
of the newly acquired tolerance. When the current again 
begins to be less perceptible close the sitting by a very slow 
and gradual reduction to zero through the rheostat. Sedative 
results require that the tissues be left at rest, and the with- 
drawal of the current must be without haste and devoid of 
any disturbing quality. When, after not less than three 
minutes spent in this final process of diminishing the current 
to zero, the seance is complete, remove the electrode. A tam- 
pon may be inserted in suitable cases. 

When the 1500 yard No. 36 coil has accomplished its work 
in a sensitive case and no longer provides sufificient current, 
or, if it is not at first adapted to cases of only moderate sensi- 
tiveness, the proper dose must be obtained by means of other 
coils, passing first to shorter coils of the No. -36 wire, and if 
these are still inadequate proceeding to the 800 yard No. 32 
coil, which will usually be the maximum until improvement is 
well advanced. In any case and during any stage of treat- 
ment the regulation of the dose by means of one coil or an- 
other IS a perfectly simple matter and wholly devoid of per- 
plexity after a single moment's instruction in the technique. 

Duration and frequency of treatment : 

Vaginal bipolar sedation cannot be hurried and rarely can 
it be overdone, for although we can over-stimulate with elec- 
tricity we cannot over-soothe. Very few cases can be properly 
treated in less than fifteen minutes. In chronic cases requir- 
ing sedative-tonic treatment rather than pure sedation the 
seance may be fifteen or twenty minutes, repeated three 
times a week. 

In sub-acute cases, which are still able to visit the ofifice, 
daily applications of from twenty to thirty minutes will pro- 



252 TREATMENT OF PELVIC DISEASES. 

duce the greatest improvement most speedily, after which the 
sittings may be three times a week and of less duration. 

Recumbent rest for some little time after each treatment is 
a rational precaution to promote the greatest benefit, but in 
ofifice practice this idea is very seldom carried out. As a rule 
the patient rises from the operating chair to walk or ride home 
immediately and resume her usual habits ; nevertheless the 
efificacy of the treatment under such conditions does not seem 
to be much impaired. The results are often remarkably good 
and are seldom disappointing even when the necessities of the 
patient overtax her strength and put rest out of the ques- 
tion. 

In a third class of cases, which the physician finds in bed 
with acute pelvic congestion or inflammation, the portable coil 
apparatus must be taken to the bedside and long applications 
of an hour or more, repeated two, three, or even four times a 
day if necessary, until the active process subsides. The dura- 
tion of the application is governed by the effect, and it must 
be long enough to produce the effect, and should be repeated 
p. r. n. 

If the hot douche, ice bag, salines, antipyretics and other 
local or systemic measures can be prescribed with benefit by 
the physician, none of them need be neglected, but the addi- 
tion of bipolar faradic sedation consummates and completes 
the resources of therapeutics. Other remedies are useful in 
their place and every educated physician must prescribe from 
the sum of his knowledge, but as a therapeutic measure for 
the relief of pelvic pain, congestion, inflammation, and the re- 
sulting infiltrations and exudations, this administration of 
high-potential rapidly-interrupted induction-coil currents by 
the bipolar method is incomparable in kind and in effects with 
any other agent in the scope of medicine. 

It is to be regarded, not only as a remedy against the symp- 
toms of acute disease of the female pelvic organs, but as an 
actual curative agent in the conditions which are within the 
limits of its therapeutic properties, and scarcely less invalu- 



TREATMENT OF PELVIC DISEASES. 253 

able as an auxiliary to other measures when the disease has 
advanced beyond its sphere of action. 

In yet other states when the condition is without hope of 
radical cure, and some surgical operation is considered neces- 
sary, bipolar faradization still serves an exceedingly useful 
purpose as a preparatory to the operation, by placing the pa- 
tient in the best possible condition to endure it. It contrib- 
utes to the success of the surgeon by improving greatly the 
local state of the tissues, the general nutrition, strength and 
nervous forces of the patient, and would, if thoroughly em- 
ployed and reinforced by the resources of galvanic current ac 
tion, clear up the prognosis and save the patient from the knife, 
in a large percentage of the cases which are now submitted to 
operation. After an operation it may be required again, to 
relieve lingering symptoms. 

Vaginal bipolar stimulation : 

Having carefully described the technique of applying seda- 



' GALVANO FARADIC MFG. CO. NY* * £ X ~ ' 



Fig. 32. A proper bipolar electrode. 

/?w currents to the pelvic parts it requires only to be said that 
exactly the .same method of bipolar application must be pur- 
sued up to the point of determining the maximum dose. The 
electrode is connected in the same way, inserted and supported 
in the same way, and beginning at zero the current is increased 
up to the point of tolerance in exactly the same manner as 
before. 

Whether this tolerance be found with the current through a 
coil composed of No. 36 wire, No 32 wire, or No 21 wire in 
any of their assorted lengths from 2,500 yards down to 200 
yards or less, the technique of dose regulation is the same. , 
The parts will, of course, be much less sensitive than in condi- 
tions when sedation is desired, and they will tolerate a much 



254 TREATMENT OF PELVIC DISEASES. 

stronger and more concentrated current, just as a paralytic and 
numb limb will tolerate and require an application which 
would aggravate an inflamed joint. 

When the dose of full comfortable tolerance is ascertained 
during the first moment or two of. any sitting the further 
effect of stimulation may be conducted along any desired gra- 
dation from the gentlest possible tonic addition to the seda- 
tive action, up to exceedingly vigorous stimulation, muscular 
contraction, and excitement of the parts. The physician is 
informed both by diagnostic experience and by the effects 
produced during the treatment exactly how to measure the 
degree of stimulation required, and there is no guesswork 
about it. The methods are methods of precision. 

The first step towards moderate stimulation is the gradual 
increase of current strength, as fast as the sensation lessens, 
so that the dosage of full tolerance is practically maintained 
during the entire seance. Instead of reducing the current to 
zero, slowly through the rheostat, at the close of the sitting 
it is now shut off abruptly by the cut -out switch. This 
leaves the tissues wakeful and alert instead of composed to 
rest, as the opposite method leaves them. 

If the case is one requiring ^gentle tonic effect, the current 
strength should not push to the extreme point of tolerance, 
and the sitting may last for fifteen or twenty minutes. It 
will partake very nearly of the nature of a sedative applica- 
tion, but while the gradual reduction of the current leaves 
the tissues in a state of rest, the abrupt stop of the same cur- 
rent results in a secondary reaction of a more tonic nature 
than the first method. 

If a greater degree of stimulation is sought it is obtained 
partly by the more rapid hastening of each step of treatment, 
holding up the maximum dose quite firmly, for five minutes, 
pushing it to the strongest current the patient can bear for 
about two minutes more, and stopping abruptly. 

Gradations of current strength and quickness in the manip- 
ulation will produce slightly different degrees of result, a;id 



TREAtMENT OF PELVIC DISEASES. 255 

enable the operator to do just what he wants and no more. 
Always avoid pain and be warned by either pain or fatigue 
to reduce the current. Neither pain nor fatigue will ever be 
caused after the first few weeks of experience in the practice 
of this method, but the novice may occasionally be less care- 
ful, and may not correctly support the electrode. Never let 
the current run down the legs. 

Still further stimulating effects may be imparted to the 
application by employing the undirlating method for a couple 
of moments, at the close of the usual sitting. Having pro- 
ceeded as before find the point of full tolerance with a steady 
current. Next produce a series of wave-like impulses of a 
momentarily stronger current by quick manipulation of the 
primary rheostat. As the resistance is suddenly and regu- 
larly shifted the current will rise and fall, and produce a 
series of rhythmical, powerful, and painless contractions, 
which cannot be equalled in character by the use of the slow 
interrupter. 

Medical judgment must control these methods, in all their 
possible delicate shadings, and conform the technique to the 
needs of the individual case. I repeat that this is perfectly 
easy to do, and presents no difficulties in either theory or 
practice. The skill required may be obtained in a couple of 
hours provided the physician possesses the groundwork of 
familiarity with electro-medical currents. 

If the operator is untrained in gynecology and bipolar 
technique, and attempts to employ a common faradic battery 
for this purpose, he will lose every patient that he inflicts his 
experiments upon, and he will think the merits of this treat- 
ment are here exaggerated. If he is reasonably expert, or 
makes himself so by clinical instruction, he will count bipolar 
faradization among his most cherished methods, and he will 
speedily discard and forever abandon the routine make-shifts 
of gynecology which it effectually supplants. 

Short sittings, usually from five to ten or fifteen minutes, 
and repeated three or four times a week, are the usual rule 



2.56 TREATMENT OF PELVIC DISEASES. 

for effects of moderate stimulation, when the physician seeks 
mainly to improve nutrition, to break up adhesions, to pro- 
mote the absorption of exudates, to tone up the uterine and 
vaginal tissues, to aid in the correction of sub-involution and 
prolapses, and produce general tonic effects. 

Extreme stimulation with maximum currents, should not 
last more than three minutes, during part of any sitting, and 
should stop short of causing local fatigue. 

Clinical Hints. — When once mastered the bipolar method 
is simplicity itself, but for the beginner there are some pre- 
cautions which require emphasis. 

With the vaginal bipolar electrode always use induction 
coil currents. Never use a galvanic current. 

Always connect the tip terminal of the electrode with the 
positive pole of the battery. 

Always employ a high grade and scientific induction appa- 
ratus with a finely adjustable rapid vibrator and full set of 
therapeutic coils. Never employ this method with any faradic 
battery which you are not certain is suited to intra-pelvicwork. 

Always keep the interrupting device brightly polished and 
accurately adjusted to a smooth and even action, for a badly 
neglected and imperfectly adjusted vibrator will destroy the 
efficiency of the best coil ever made. 

Always retain the electrode to its full depth within the va- 
gina; never allow it to slip out and touch the labia while the 
current is in action. 

Always insert the electrode before starting the current, and 
always gradually increase the current strength from zero by 
means of the rheostat, which controls all currents to absolute 
zero at the commencement. Never suddenly make an altera- 
tion in the current during the treatment which will startle or 
pain the patient, and the author's secondary circuit rheostat 
obviates the liability of doing this. 

Never employ a dosage that causes pain. All the good ef- 
fects of this method are obtained without any pain whatever, 
and with decided comfort to the patient. 



TREATMENT OF PELVIC DISEASES. 257 

Always use the rapid vibrator, adjusted to its most rapid 
rate. 

A clean vibrator will rarely stop during treatment, but a 
neglected vibrator will frequently stop. If this happens, 
always decrease the current before readjusting or starting 
it again. This avoids annoyance to the patient. 

At the end of a stimulating application always shut off the 
current suddenly. 

At the end of a sedative application always reduce the cur- 
rent gradually and slowly to zero. 

Always, in every case, stop the current completely before 
withdrawing the electrode. 

Never use an apparatus that does not possess an adjustable 
rapid vibrator, giving a smooth current, free from all irregular- 
ities, and of not less than three hundred periods per second. 

Never soak the bipolar electrode in any solution. Cleanse 
it by quickly washing the lower two-thirds in a carbolic or cre- 
olin solution, but do not allow water to enter the holes in the 
handle in which the cord tips are inserted. 

Always test a new electrode with the hand to make sure 
that the conducting and insulating parts work properly, as an 
accident in construction may either make it a mono-polar elec- 
trode, or defective in other ways. It is obvious that the eiifects 
of the current will be rendered nugatory if the electrode hap- 
pens to be defective, and a simple test will prevent disappoint- 
ment. 

Always unload the rectum, and regulate the action of the 
bowels. Never administer a vaginal bipolar faradic current 
with a loaded rectum. 

When directing the vaginal bipolar electrode be sure the 
tip is not pressing upon the muscles of the thigh. If the pa- 
tient feels the current cramp the leg with a mild dosage, the 
current is side-tracked, and not going in the right direction. 
The true vaginal tolerance is far in excess of the tolerance of 
the thigh muscles, and the beginner must learn to put the 
electrode in the right place. 



2S8 TREATMENT OF PELVIC DISEASES. 

Intra-Uterine Bipolar Applications.— It will be observed 
that few references are made in this book to the treatment of 
patients by intra-uterine bipolar faradization. Probably the 
perusal of works on the subject would give the general practi- 
tioner the idea that there was little difference between vaginal 
and intra-uterine bipolar technique, and that one was employed 
indifferently as much as the other. 

Theoretical advantages indeed belong to this direct method 
of affecting the uterine body, but in practice some of the elec- 
trodes manufactured for this purpose are difficult to render 
aseptic by either heat or the usual solutions. There is nothing 
germicidal about the action of the current from induction coils, 
and the dictates of prudence suggest that the intra-uterine bi- 
polar electrode should be used with great caution, and only by 
an expert. 

It is really seldom required, and it involves no hardship to 
regard the instrument as unsuited to the purposes of the gen- 
eral practitioner. 





Fig. 33. Intra-uterine bipolar electrode. (Faradic.) 

Moreover, the very conditions for which the intra-uterine 
application would be theoretically indicated are those in which 
we should often let it alone. When the canal is irritable, hy- 
persemic and sensitive, so as to need sedation, the most gentle 
insertion of an electrode is indiscreet, and the vaginal method 
answers the purpose of sedation quite efficiently. Experience 
will teach the operator to get along without very aggressive 
measures within the uterus. 

In all references to bipolar methods in this volume it may 
be understood, unless otherwise stated, that the author refers 
to the vaginal electrode only. If it is desired to apply coil 
currents to the uterine cavity the mono-polar method, with a 



TREATMENT OF PELVIC DISEASES. 259 

metallic electrode which can be thoroughly sterilized, and a 
large dispersing electrode on the abdomen or under the sacrum, 
offers about all the advantages with none of the dangers that 
surround the use of an electrode which cannot easily be made 
surgically clean. 

Massage in Gynecology. — A comparison between manual 
massage within the pelvis and the superior action of electrical 
massage and electrolysis may profitably be made by reading 
an abstract of reports such as follows : 

M. Ponomareff has employed massage for different troubles 
of the pelvic organs of women. This method is indicated in 
the following maladies : Imperfect involution of the uterus 
after labor and especially after miscarriage. In this class of 
cases massage rapidly diminished the size of the uterus. It 
prevents hemorrhage as well as the development of chronic 
troubles. 2. Chronic metritis, before it reaches the point of 
sclerosis, but accompanied with endometritis and dysmenor- 
rhoea. 3. P^fective position of the uterus and ovaries. Mas- 
sage acts favorably in these cases on the uterus and its liga- 
ments, and thus permits a correction of the defective position 
of the pelvic organs. 4. Perimetritis and chronic parame- 
tritis are favorably influenced by massage ; the exudates are 
reabsorbed, the adhesions become more pliable and very often 
disappear. 5. Gynecological massage is of great diagnostic 
value, as, for instance, when the demarcation is not very clear 
between the uterus and a benign tumor. By diminishing the 
congestion of the uterus, massage permits of a more precise 
diagnosis. The following are the cases in which gynecological 
massage is contra-indicated, (a) Pregnancy (normal and ex- 
tra uterine). {i>) Malignant tumors of the pelvic organs, {c) 
All the diseases accompanied by suppuration, tubal blennor- 
rhagia, and blennorrhagic perisalpingitis, (d) Acute febrile 
affections. The manual operation employed by the author 
was very simple ; the finger, placed in the vagina or rectum, 
remains fixed and holds the diseased organ in place. With the 
hand placed on the abdomen, friction of the affected organ is 
executed across the abdominal wall, which ought to be relaxed 
as much as possible. The patient is placed in the dorsal decu- 
bitus, with the knees flexed. The seances should take place 
every day, or every other day, for a period of from five to ten 
minutes." 

It will be seen that indications given for gynecological mas- 



26o TREATMENT OF PELVIC DISEASES. 

sage follow quite imperfectly the indications for vaginal bipo- 
lar faradizations. The crudity of the manual method and the 
objections to which it is open, offer decided contrast to the 
unobjectionable technique of the instrumental method. As 
regards therapeutic effects there is little to be said. One 
method belongs to the barbaric age of medicine, the other is 
among its most scientific achievements. The abuses of the 
;nanual method have caused it to be severely condemned, while 
the best results it secures, in the hands of an occasional master 
of technique, cannot be duplicated by one general practitioner 
out of ten thousand. The bipolar method need never be 
abused, demands no gift of genius and years of training for 
its best employment, and it will produce in the hands of every 
general practitioner who takes the trouble to get the electrode 
and the proper battery (and spend a few hours learning how 
to use them) all the valuable effects which make it indispens- 
able in the treatment of pelvic diseases. 

Faradic Apparatus for Pelvic Practice. — The common 
faradic battery is unfit for gynecological uses. The best far- 
adic battery of the ordinary type is inferior, and if employed 
at all, requires to be supplemented by finer currents for seda- 
tive and anodyne effects in all cases in which congestion or 
inflammation is present. 

An apparatus suited to produce all grades of sedative, 
tonic, nutritional, vaso-constrictor, stimulating and other thera- 
peutic effects within the range of induction coil currents 
must be of a superior type. The author's apparatus is per- 
fectly satisfactory. The compound high tension coil furnishes 
every variety of current included in the term faradic. It con- 
tains ample E. M. F., having six cells, any number of which 
can be separately employed. An excess of E. M. F. can 
always be used to keep the rapid vibrator in perfect action 
while the rheostat in the secondary circuit controls all currents 
independently of the vibrator. Every current therefore begins 
at zero, so far as the patient is concerned, and is regulated 
smoothly and absolutely without shock, to the required dose. 



TREATMENT OF PELVIC DISEASES. 



261 



This is an immense convenience in vaginal applications. 
From actual zero to the maximum current which the most 
powerful coil and any E. M. F. from one to six cells delivers 
to the patient, the dose is regulated with absolute comfort by 
the improved rheostat which I designed three years ago, and 




Fig. 34- 

Author's Induction coil apparatus suited to all gynecological applications by bi- 
polar or mono-polar methods. 

which has been found indispensable by all operators who are 
the fortunate possessors of this improved apparatus. 

The rheostat is neither large nor costly, but is a simple 
pair of tubes of glass each containing a compound liquid re- 
sistance. The disagreeable irregularity in all common faradic 
currents bars them from use within the pelvis. Both the 
rapid and slow vibrator in the author's apparatus are complete- 
ly adjustable and attain a maximum of evenness with ordinary 
care. 



252 TREATMENT OF PELVIC DISEASES. 

It is certain, therefore, that for at least three years a perfe 
ly satisfactory high tension induction coil apparatus has be 
furnished the profession by the Jerome Kidder Mfg. Co., 
New York City, and writers who at this late date are depl 
ing their own lack of a suitable battery may be glad to lea 
that in the author's induction coil apparatus they have t 
means not only of obtaining the best results of coil curret 
in pelvic diseases, but require no other faradic battery 1 
any other purposes which induction currents fulfil in the 
peutics. 

Galvanic Precautions Throughout this book it is und 

stood that in all cases not otherwise stated, the felt, sponj 
cotton, or clay, covering the external electrode is prepared i 
application to the patient by soaking it in hot water, to whi 
about one or two per cent, of soda bicarbonate has been addc 
and never in plain water alone. 

When saturated with this conducting solution the excess 
moisture only should be squeezed out, leaving the felt 
sponge as moist as possible, without dripping and wetting t 
patient's clothes. The electrode should be applied to t 
patient as hot as can be comfortably borne, and always at t 
beginning of the getting ready process, so that the tissues m 
become softened while other preparations for treatme 
are made. To prevent wetting the patient's clothes the ele 
rode should be covered with a thick towel placed between 
and the wearing apparel. Each electrode has also a rubl 
back. 

Galvanic electrodes require all the moisture which they c 
retain without dripping, for the low voltage of the curn 
makes the softening of the skin and the lessening of the i 
ternal resistance a matter of great importance. Faradic el 
trodes may be simply damp, but a galvanic electrode must 
wet. 

The above facts will be repeated in the details of separ; 
applications a sufficient number of times to serve as a remim 
to the physician, but it will not be considered necessary 



TREATMENT OF PELVIC DISEASES. 263 

mention them always, for they belong to the rudimentary 
A B C of the subject which all can understand from a single 
statement. 

While it is necessary to state amperage in approximate doses 
in describing the various applications of galvanic currents, yet 
allowance must be made for the varying susceptibilities of the 
skin and mucous membrane. The dosage must be regulated, 
not by figures but by effects. Any amperage that produces the 
desired effect is the true dosage for the individual case, although 
some other person might require an increase or reduction of 
the amperage to obtain the same effects. 

Conditions regulate the dosage, and experience teaches the 
operator to understand the conditions. 

If the desired effect is a physiological action which requires 
a definitely ascertained amperage, there will probably be no 
other hindrance to its administration than a possible disagree- 
able sensation if the dispersing electrode is too small, or is not 
properly prepared to lessen the resistance of the skin. In all 
these cases a perfectly comfortable tolerance is easily secured 
by following the directions in this book. 

In specific cases, when known intensities between 50, and 
1 50 milliamperes are required to produce chemical cauterizing 
and other effects, the dosage must be reached, not against the 
tolerance of the patient so that suffering is caused, but by 
largely increasing the area of the external electrode, by care- 
fully preparing the skin to the highest point of conductivity, 
and by employing electrodes of the best conducting material. 
In these cases tolerance for the dispersing electrode must be 
created, and without this precaution large currents cannot be 
administered. The lessons of practical experience become 
valuable to the operator in securing comfort to his patient 
when maximum doses are applied. 

Always use precautions in withdrawing the positive intra- 
uterine electrode when using above 30 mil. Never pull it out 
abruptly, but reduce current to zero and reverse the current to 
loosen the tissues that clasp the electrode. 



264 TREATMENT OF PELVIC DISEASES. 

A ntiseptic precautions : 

In office practice a cleansing vaginal douche may be given 
before, and also after, some of the extreme cases in which 
intra-uterine applications require all possible precautions 
against sepsis. This double douche is very rarely needed. 
In all ordinary conditions it suffices to dip a pledget of cotton 
in a carbolic or creolin solution and swab out the vagina and 
cervical canal after inserting the clean speculum and before 
inserting the sterilized electrode. 

This does not require stating repeatedly in the directions 
for each separate application, but will be understood by the 
physician to apply to all vaginal and uterine methods de- 
scribed. The electrode must be clean, but that belongs to 
the rudimentary knowledge of the use of instruments, and one 
mention of the fact is enough. 




Fig- 35- 

Electrode for Vaginal Hydro-Electric applications. Useful in pelvic exudates, 
ovaritis, vaginitis, vulvitis, eczema of the vulva, etc. Also for cleansing irrigation. 

Antiseptic Irrigation of the Vagina. — In all cases in which 
vaginal irrigation is a wise precaution before an intra-uterine 
treatment, it is a neat point in practice to employ for this pur- 
pose the vaginal douche electrode. It is one of the most con- 
venient and perfect means of giving a cleansing douche that 
can be employed, without any liability of wetting the patient's 
garments or the operator. The outflow F is directed into a 
pan on the shelf under the operating table in all cases, whether 
it is employed as a simple douche or as an electrode. 



TREATMENT OF PELVIC DISEASES. 265 

How to Regulate Current Strength to the Point of Maxi- 
mum Tolerance with either Positive or Negative Galvanic 
Applications. — A knowledge of how to secure perfect toler- 
ance at the dispersing electrode when employing large, currents 
within the uterus, and the exact method of reaching the maxi- 
mum dose, is of vital importance in successful practice. 

With the electrodes in position and the dose already raised 
from zero to the point of decided sensation, continue to in- 
crease it gradually through the rheostat until possibly a slight 
pain is provoked. Pause for a moment and the irritation will 
usually disappear. 

If the dose is still considerably below the desired amperage 
and the pain is felt only at the dispersing electrode, this must 
be increased in contact area provided that it has been saturated 
and prepared and applied in the proper manner as I have de- 
scribed elsewhere. If these conditions are correct and the 
irritability is the fault of an eruptive state of the skin, the 
electrode may be removed to the next most convenient and 
available situation, if it is possible to do so ; but in intra-pelvic 
practice the external situations are practically limited to the 
abdomen and the lower spine. 

If there is no fault of the skin, and if one large electrode is 
not sufficient, two can be easily applied with a bifurcated cord 
which connects them both to the same pole of the battery. 

The conductivity of the skin can also be increased by pre- 
viously shampooing it with hot water and soap, or ammonia, 
in the region where the electrode is to be placed. 

With these precautions, which will be necessary if the am- 
perage is to exceed 100, the current may again be advanced 
with little or no disagreeable sensation until we reach the 
point which actually determines the dose, i. e. consciousness 
of the current at the internal electrode. Until this is declared 
there has been no approach to full tolerance, for the tolera- 
tion, great or little, at the dispersing electrode has nothing to 
do with the true dose regulation. 

If still greater cauterizing action is desired cautiously in- 



266 TREATMENT OF PELVIC DISEASES. 

crease the amperage (after a moment) until actual pain is pro- 
duced, and if this does not at once subside upon maintaining 
the same amperage for an instant, reduce the strength very 
slowly until the intensity ceases to tax the patient's endurance. 

If this established amperage is sufificient to produce the de- 
sired therapeutic effect, there need be no further attempt to 
increase it, and it will become more comfortable during treat- 
ment instead of less so. 

If it is still below the dose believed to be required, it is 
useless to attempt to increase it at the same sitting. We 
must wait until gradual improvement in the tissues during 
successive applications produces an increasing tolerance, and 
permits it to be safely done. 

If tolerance decreases, instead of indicating an improve- 
ment by increasing in the usual manner, it is always a warn- 
ing that the electro-therapeutist must heed. Either the dose 
has been too great, or the application has been improperly 
made, or some other treatment is indicated instead. 

Pain during, or after, galvanic applications, is generally a 
signal for caution if it occurs at the internal electrode ; other- 
wise, it is only a notice to use a larger and better conducting 
surface externally. 

If pain unexpectedly follows any intra-uterine application 
of positive or negative galvanic currents of high intensity, 
the operator should immediately substitute the vaginal bi- 
polar electrode and allay the irritability with long coil, far- 
adic sedation. This will obviate almost all the aggravations 
the operator may cause while he is acquiring the intuitive 
skill which comes with practical training. 

In the use of high intensity doses of constant currents the 
regularity of treatment may be interrupted by temporary 
complications, and no treatment which has resulted in irrita- 
tion, either intentional or accidental, should be repeated until 
the effect of it has completely disappeared, and a milder 
dosage should be employed. 

If irritation follows ekch attempt to pursue a special intra- 



TREATMENT OF PELVIC DISEASES. 267 

uterine treatment supposed to be indicated, be warned by it 
and substitute some other method which will produce good 
effects without irritation. 

Aids to the Diagnosis of Pelvic Lesions. — If a patient 
complains of intense sensitiveness to manipulation, during an 
attempted digital examination, so that an acute congestive 
or inflammatory state is suspected, immediately insert a 
vaginal bipolar electrode, and test the greatest tolerance to a 
rapidly interrupted high tension coil current, that can be de- 
veloped during about ten minutes. No matter how violent 
the patient may declare the pain to be, or how great the 
apparent tenderness to touch, the condition is not inflamma- 
toiy if currents from medium coils with the full E. M. F. of 
three or four cells are comfortably tolerated. 

If the pain and sensitiveness promptly disappears under 
one or several applications of bipolar faradic sedation, it was 
of a simple congestive or nervous character, or dependent 
upon some functional derangement which the action of coil 
currents control. 

If only a comparatively weak current from the 1 500 yard 
No 36 coil with less than the full E. M. F. of four cells is 
comfortably endured, and if the effect of sedation is more 
slowly accomplished and lasts but a short time after the sit- 
ting, the pain is probably due to an inflammation of the 
appendages, when it is referred by the patient to the ovarian 
region. 

If ovarian pain does not progressively improve under eight 
or ten'proper applications of vaginal bipolar faradic sedation, 
the lesion is probably not a simple chronic inflammation, but 
is compHcated with organic disease of more serious nature. 

If peri-uterine lesions are either suspected or unsuspected, 
or if their presence is ascertained but their nature not deter- 
mined, a study of the tolerance or intolerance, of the intra- 
uterine galvanic dosage, during four or five experimental 
treatments will do much to establish the clinical diagnosis, or 
formulate the proper treatment. 



268 TREATMENT OF PELVIC DISEASES. 

If a first intra-uterine galvanic application is made, and the 
dose carried to the point of comfortable tolerance we may 
conclude : 

1. If the tissues are intolerant, and cause pain and distress 
when the dose does not pass beyond 40 mil. there is some 
acute peri-uterine inflammation of either the appendages or 
the peritoneum, or of the pelvic cellular tissues. 

2. The intensity, extent, and gravity, of the inflammatory 
lesion is generally proportionate to the increase in the amperage 
of the current employed, and in inverse ratio. 

3. If it rapidly causes severe pain and febrile reaction after 
passing 40 or 50 mil. a suppurating process may be suspected. 

If this intolerance is maintained during the entire treat- 
ment and does not abate, and is again manifested during the 
next similar experimental treatments, made two or three days 
later, and especially if the patient reports symptoms of chilli- 
ness and fever during the balance of the day following the 
sitting (or the next morning) it indicates that the inflamma- 
tory lesion is of a suppurative or other nature, which is in- 
curable by conservative means. The application of intra- 
uterine currents of high intensity is therefore contra-indicated, 
but other palliative electrical measures may be employed, 
or an operation advised, according to the indications. 

If the tissues manifest a better tolerance toward the end of 
a sitting than at the beginning, and if the patient experiences 
no other pains or distress except the normal " colic " of the 
contracting uterus after a strong positive application, and, if 
she continues to comfortably tolerate a higher amperage at 
each sitting, it is demonstrated that there is either no disease 
of the appendages or that any lesion of a chronic inflamma- 
tory character is simple and does not require operation. 
Such a case may be either radically or at least symptomati- 
cally cured by electrical treatment. 

If (somewhat between these two classes) we find that the 
current causes more or less complaint without febrile symp- 
toms the cause of the fictitious intolerance may be hysteria 



TREATMENT OF PELVIC DISEASES. 269 

which will be controlled by bipolar faradization and static 
electricity ; or this kind of intolerance may occur in fibro- 
cystic tumors. 

Simple cystic, peri-uterine tumors, which are neither in- 
flamed nor suppurating (such as ovarian cysts and hydro-sal- 
pinx) may also show perfect tolerance of the galvanic current, 
and if not curable themselves by electrical treatment will not 
contra-indicate its employment for any other purposes for 
which it is especially indicated. 

The study of the tolerance or intolerance of the intra-uterine 
galvanic current, and especially of the symptoms, if any occur 
within a few hours after the application,furnishes an immediate 
caution to the operator, and after several treatments given ex- 
perimentally at intervals of two or three days, informs him of 
the condition with which he has to deal. 

The same study of the results in cases in which the indica- 
tions modify, but do not reject electrical treatment, will also de- 
termine rapidly (within eight or ten stances) the curability of 
the lesions, or their incurability by electrical methods, or the 
degree of symptomatic benefit which may be expected without 
a radical cure. 

It thus decides very often : (i) when an operation is urgent ; 
(2) when it may be indefinitely postponed, and (3) when it may 
be abstained from altogether. 

It is the general consensus of opinion that the above teach- 
ings, which follow the immense experience of Apostoli, are re- 
liable, and that many cuttings, exploratory operations, and 
various mutilations practised for the relief of ovarian pain, or 
for lesions of the appendages of uncertain nature, should be 
delayed or declined until all the resources of faradic sedation 
on the one hand, and of the intra-uterine galvanic reaction on 
the other, have been tried. These methods require only proper 
apparatus and reasonable skill to shed precious light upon the 
diagnosis, and thus serve both as priceless remedial agents, 
and as the defence of the patient against avoidable or injudi- 
cious surgery. 



270 TREATMENT OF PELVIC DISEASES. 

Indications for Electricity in Gynecology. — Questions on 
this point are regularly asked by many practitioners who first 
make no attempt to post themselves upon the A B C of med- 
ical electricity. The discussions in meetings of gynecological 
societies are fruitful of inquiries of this nature. Some of 
them expose the vagueness in which the neglect of medical 
colleges has left electro-therapeutics in the average medical 
mind. To many physicians electricity is something intan- 
gible, a haphazard agent, limited in action to stimulating 
muscles or producing heat, a sort of hit-or-miss therapeutic 
lottery, negligible altogether or to be tried only as a " last re- 
sort '' when everything else has failed. 

It may be laconically said that the indications for electricity 
are pretty well understood by those who understand them, 
but they are not understood by those who do not understand 
them. The multiplication table is plain enough to a child 
who understands it, but it is a hard matter to those who don't. 

The true answer to a large question of this kind can be 
found by all physicians in the careful and intelligent study of 
the whole subject of electro-physiology and electro-therapeu- 
tics, and the qualities of difference imparted to electrical cur- 
rents by different mechanical devices and by dose regulation. 
Those who stand afar off and regard the subject through the 
mists and the mirage of distance will be amazed to find how 
clear and explicit and exact the details of the subject become 
when they are inspected at close range. Not the least satis- 
factory part of the use of electrical currents is the clearness of 
the indications for each leading method. 

But it is as well to ask what is the indication for administer- 
ing water, without considering the methods of scientific hy- 
drotherapy, as to ask this superficial question of electricity — 
as if it were a drug of but one preparation, one dose, one 
method of " taking," and no definite action whatever. 

The apparent and ascertained indications for the use of elec- 
tric currents in pelvic affections take into account the various 
demonstrated properties of galvanic, induction coil, and static 



TREATMENT OF PELVIC DISEASES. 27 1 

currents, and are governed in practice by the completeness 
or incompleteness of the physician's apparatus, and his skill 
in electrical technique. The disputes in open discussions of 
the subject do not arise from the essential difficulties of the 
subject, for few exist, but from the fact that two practitioners 
will not think alike if one has a modern, high-efficiency and 
complete equipment, and the other only a twenty or thirty- 
dollar " faradic " battery. 

If the latter takes himself and his inferior battery seriously, 
he will be able to demonstrate that " he cannot secure the re- 
sults claimed by enthusiastic operators," and plenty of his fol- 
lowers will believe that his experience proves electricity to be 
" over-rated." 

The physician, however, who is equipped with a complete 
fifty or sixty-cell galvanic cabinet, meter, rheostat, and inter- 
rupter, a scientific coil apparatus giving the manifold variations 
of induction currents now at our command, a static machine 
of not less than six or eight plates, twenty-six, twenty-eight or 
thirty inches in diameter, and an assortment of from one to 
two hundred proper electrodes, and who is adept in the uses 
thereof, will state that he can select and beneficially apply 
some form of current in some properly regulated dose in 
every deviation from the normal health which is not dis- 
tinctly within the province of either curative medicine or of 
the surgeon. 

Such a practitioner will state that as compared with topical 
routines, still generally in vogue, the advancement of electro- 
gynecology beyond the common faradic battery is as great as 
the strides from the canal boat to the ocean greyhound ; that 
in expert hands the dosage of electricity is safe in all currents 
and methods, and that many of the most valuable applications 
can be made by the general physician as well as by the spe- 
cialist. He will clearly define the limitations of this agent in 
the cure of disease, and its useful services in the relief of in- 
curable conditions, and he will state when to prefer the fa- 
miliar methods of medical prescribing with the same exactness 



272 TREATMENT OF PELVIC DISEASES. 

with which he is able to set forth the contra-indications for 
electricity. 

Contra-indications. — Probably all who have read any treat- 
ise upon this subject are now aware of the well-known and 
chief contra-indications in gynecological electro-therapeutics. 
These may practically be grouped as malignant disease, fibro- 
cystic tumors of the uterus, fibroid tumors complicated by 
suppurating and grave lesions of the adnexa, and the presence 
of pus in the pelvis which should be evacuated. 

The character also of other conditions which electricity will 
not benefit is well defined. Ovarian tumors belong to this 
class; so do about fifteen per cent of advanced fibroids which 
have deformed the uterine canal so that an electrode cannot be 
inserted ; so do submucous and polypoid growths within the 
uterus and so do anatomical injuries which only the surgeon 
can repair, but in some of the above lesions we can abate pain 
and control some symptoms, and after operation do the patient 
much good with electricity. 

The great field for electricity in gynecology lies between 
the conditions which are readily amenable to medical prescrib- 
ing and the proper sphere of radical surgery. Covering the 
wide range of usefulness between these two extremes it occu- 
pies vastly more than the middle ground. It is the most im- 
portant single agent known to medicine in this branch of work, 
and its usefulness is not restricted to cases in which everything 
else has failed, or in which its unaided action will produce a 
cure. 

In some cases it answers every purpose alone. In other 
cases it will require the aid of other resources of medicine. In 
other cases it will co-operate efficiently with other remedies 
and especially with conservative or radical surgery, and lend 
ever a helping hand which affords comfort to the patient even 
though its direct action upon some diseases is a minor one. 

Intra-Uterine Cauterization.— The popular understanding 
of the word cautery involves a searing and burning effect. It 
is essential to understand something entirely different in the 



TREATMENT OF PELVIC DISEASES. 273 

meaning of the word cauterization by medical galvanic cur- 
rents. The term is not satisfactory to indicate the action 
which takes place, but I employ it because it is in general use, 
and will serve the purpose, if its modified meaning is made 
clear to the mind of the physician. 

Through the teachings of Apostoli the world has become 
familiar with the fact that those who use his methods apply 
to the lining of the uterus a galvanic current with a bare metal 
electrode, and produce effects with certain doses of current 
strength which are called galvanp-cauterization, while the ef- 
fects of lesser and medium doses are referred to as galvano- 
caustic. The so-called cauterizing application is an electrolytic 
action increased in rapidity by an increase in the rate of current 
flow. It is an /«/««j^ electrolysis of the tissues maintained for 
the short space of about three minutes, and is as different from 
the searing of the actual cautery as the proper cooking of a 
roast of beef is different from the burning of the same roast to 
a charred cinder. One furnishes nourishing food for the re- 
pair of the tissues, the other absolutely destroys. 

The medical galvanic current is obtained from ordinary cells 
connected in one, two, three, order so that a gradual increase 
in voltage and milliamperes go hand in hand together, accord- 
ing to the number of cells employed in a given treatment, and 
proportioned to the resistance in the circuit. The factor of 
resistance modifies every application. The current which 
passes through the tissues between the two electrodes is always 
small, and the effects may properly be termed medical. 

The cautery battery is not made up of from forty to sixty 
cells connected in series, but of one, two, or about four cells 
connected m parallel, and furnished with zincs and carbons of 
extra large size. The resulting current from this batteiy is 
well-nigh all amperage— irom 10 to 100 times greater than any 
medical dosage actiiig within tissues. When concentrated at 
a point of resistance it is converted into heat and heats a plat- 
inum knife to a white heat or cherry red for cauterizing use 
only. The cautery current is never passed through tissues be- 



274 TREATMENT OF PELVIC DISEASES. 

twccn two electrodes. Its effects may properly be called sur. 
gical, and they are as foreign to ike action of medical galvanic 
currents as these are employed therapeutically throughout the 
zvorld, as would the action of a cutting knife in the hand of a 
masseur be foreign to massage. 

Taking up a volume of a large System of Gynecology I find 
the following remarks : 

" Local treatment of diseases of the uterus should be em- 
ployed for two objects, to remove the disease, to restore the 
organ to health and leave it uninjured in structure. The 
therapeutist is bound at once to reject all the more powerful 
and destructive agents. The nitric and chromic acids and 
other caustics are being laid aside, but only, I fear, to give 
place in some cases to new, but none the less destructive, 
agents. I allude to galvano-cautery and thermo-cautery. I 
most thoroughly appreciate their value in the treatment of 
malignant disease when the destruction of tissue is called for, 
but in the treatment of benign inflammation, chronic endome- 
tritis or hyperaemia of the mucous membrane of the cavity of 
the uterus they cannot fail to work a great and uncalled-for 
destruction." 

The general practitioner who is reading up a case in a stand- 
ard text-book may consider the point apparently made an im- 
portant one. No cautery burning of the above character is 
practised by Apostoli or any of his rational followers. 

When constant galvanic currents are applied to the endo- 
metrium with an electrode of comparatively large surface, 
many times larger than the searing cautery loop, and are 
driven into the tissues by the usual voltage which is required 
to develop 75, 100 or 150 mil. of current strength, there is not 
only a good deal of diffusion of the local polar action, but the 
electrode remains far below the temperature of the red-hot 
searing wire. The contrast between the two is so great that 
there is no other room than the play of the completely ignorant 
imagination to confound the two in practical electro-thera- 
peutics. 

To burn out the whole mucous membrane of the uterus with 
the hot, scaring, destructive cautery for the cure of an inflam- 



TREATMENT OF PELVIC DISEASES. 275 

mation is not a conceivable act. Instruments are not used in 
such a way. Tlie so-called cauterization for the cure of endo- 
metritis by medical galvanic currents is a reparative and not 
destructive process and restores the normal functions of the 
organ so that pregnancy has resulted in many cases. This 
fact alone is proof of the enormous difference between the 
good results obtained in practice, and the theoretical fears 
expressed. 



CHAPTER XVI. 

TREATMENT OF MENSTRUAL DERANGEMENTS. 

Simple Amenorrhoea. External and internal methods of treatment with both 
galvanic and faradic currents. Amenorrhcea due to chronic degenerative 
changes. Clinical remarks. Amenorrhoea from deficient uterine develop, 
ment. Amenorrhcea following surgical operations. Diminished menstrua- 
tion in plethoric women. Scanty and irregular menstruation. Menstrual 
apathy following shock, etc. Simple delayed menstruation. Remarks. 

Simple Amenorrhcea. — Galvanic, faradic, and static currents, 
by both external and intra-pelvic applications, are available for 
the successful treatment of this condition, and either aid the 
action of essential constitutional remedies or unaided accom- 
plish results which can be obtained by no other safe resource 
of therapeutics. 

In the simplest form of Amenorrhoea in girls whose functions 
have delayed maturing ; in chlorosis, spinal and pelvic anaemia ; 
in depressing mental states, and in general when there are no 
evidences of a local pathological condition, when intra-vaginal 
examinations or methods are undesirable, and when medical 
judgment regards the encouragement of menstruation as 
indicated, we may supplement other hygienic and medicinal 
measures by external, nutritional and tonic applications to 
the spine. 

For this purpose either of three currents is useful and the 
actions of all are exceedingly beneficial. As the static current 
may be employed without disrobing it may often be the first 
choice and its efficiency in simple cases leaves nothing to be 
desired. 

The rule for insuring success in this class of cases associated 

with chlorosis, anaemia, and other states of general ill health 

276 



TREATMErIT OF MENSTRUAL DERANGEMENTS. 277 

ites to applying mild static sparks as a local stimulant to an 
;an whose functions remain deficient after the general health 
i otherwise been restored. Improve the general health by 
;rcise and tonics, remove the accumulations often present 
the bowels by appropriate medication, and then a few static 
irks will be suiificient to at once restore the previously 
iicient discharge. " It is for want of attending to this rule 
it so many cases have been said to have been unsuccessfully 
ated by static electricity." {Bird.) 

Static. — Seat the patient upon the static platform and 
minister positive electrification for about eight minutes. 
3p the machine, change the platform connection to the 
jative pole, and ground both the positive pole and the brass 
int electrode. Administer a tonic positive spray to the spine 
i over the lower abdomen for five minutes. In chlorotic, 
:hectic, and depraved states of health requiring prolonged 
istitutional upbuilding, this treatment may be repeated 
■ee times a week for a couple of months, in conjunction with 
Y remedies that may be judiciously prescribed. 
hs soon as the patient will accept mild sparks to the spine 
3 ovarian region they should be applied at the close of each 
nee. In cases not requiring sustained and regular treat- 
nt, and in the latter portion of the care of those who have 
eived sufficient constitutional improvement, the static appli- 
ion may be limited to daily sittings three days before the 
Dected flow. 

Before the development of the high-tension induction coil, 
1 the improved galvanic and faradic methods of Apostoli, 
I static spark was facile princeps in the realm of electro- 
irapeutics as a regulator of the menstrual function. It is as 
cient to-day as it ever was, but it has been for the most 
t superseded by methods which are better in many cases, 
i yet it may be employed if desired in a large number of 
es when only a local stimulation is required and when the 
)osure of the person for more direct treatment would be 
ised. 



278 



TREATMENT OF MENSTRUAL DERANGEMENTS. 



Percutaneous Galvanic. — In young girls, or in other cases 
in which external treatment only is deemed judicious, we may 
regulate personal hygiene and prescribe indicated remedies and 
in addition derive great help from percutaneous applications 
of tonic galvanism. ' 

Place a felt-covered, flat electrode, 5X8, under the cervical 
spine or lumbar region, and a similar one over the lower abdo- 
men. Make the spinal electrode positive and the other nega- 
tive. Thoroughly saturate them both with the usual hot 




Fig. 36. Fine felt or sponge covered electrode— assorted sizes with soft rubber 

insulating backs. 

solution of soda bicarbonate. Pass a constant galvanic current, 
gradually increased from zero up to 20 or 40 mil, according to 
tolerance of the skin, for 15 minutes. Reduce current to zero, 
switch the automatic rheotome into circuit adjusted to a rate 
of between two and three hundred interruptions per minute, 
and again increase the current until agreeable pulsations are 
felt through both electrodes. In about five minutes reduce 
current to zero and close the sitting. Dust the skin with toilet 
powder after removing the electrodes. 

Repeat two or three times a week between menstrual periods 
for a couple of months. This application not only improves 



TREATMENT OF MENSTRUAL DERANGEMENTS. 



279 



the pelvic nutrition and circulation but also produces a bene- 
ficial effect upon the general nervous system. During the 
application of the constant current the situation of the spinal 
electrode may relate to either the upper or lower centres, and 
it is sometimes well to alternate the position at different 
sittings. During the application of the interrupted current the 
posterior electrode should always be placed beneath the lumbo- 
sacral region. 

Spinal galvanization. — With the patient recumbent on a 
couch the galvanic current may be applied to the spine by 





Fig. 37. Fine felt or sponge covered electrodes — assorted sizes with soft rubber 

insulating backs. 



exposing only so much of the upper and lower surface as will 
permit a felt-covered, flat electrode about 4 X 6 to be placed 



28o TREATMENT OF MENSTRUAL DERANGEMENTS. 

at the back of the neck and a similar electrode upon the lumbo- 
sacral region. 

Connect the upper electrode with the positive pole and make 
the lower electrode negative. Gradually increase the constant 
galvanic current from zero up to about 20 mil., keeping within 
a comfortable tolerance, and maintain its action for about ten 
minutes. Repeat three times a week. 

If the flow at the succeeding period is not free, persist until 
it becomes satisfactory, and thereafter apply the same treat- 
ment for two or three days just prior to the expected flow 
until several normal periods have been passed. 

As treatment progresses the surface tolerance to the current 
will often increase and the dose may be somewhat increased 
accordingly, but as the inaxinmm of current strength in gal- 
vanic applications is always very gradually developed and the 
reduction to zero at the close of treatment is also gradual and 
should never be abrupt, it is obvious that during a ten minute 
application we need consider only about one-half of this time 
as representing the maximum current activity. 

After removing the electrodes dust the reddened skin with 
toilet powder and the patient is ready to dress. 

Spinal faradization. — This faradic method requires the ex- 
posure of the entire spine with the patient reclining face down- 
ward upon a table or couch. Apply a sponge-covered posi- 
tive electrode of medium size upon the nape of the neck and 




Fig. 38. Sponge-covered flat electrode. 

regulate a medium-coil, rapidly-interrupted current to a strength 
which causes an agreeable sensation and mild muscular con- 



TREATMENT OF MENSTRUAL DERANGEMENTS. 281 

traction at all points of the spine when the negative electrode 
is promenaded up and down its entire length. An ordinary 
sponge-covered hand electrode lubricated with a little soap 
answers for this purpose. At each side of the spine the elec- 
trode may be passed a few times over the various motor points 
and also across the muscles of the lumbar region. 



Fig. 39. Ordinary sponge-covered hand electrode. 

Devote about ten minutes to the entire application, giving 
the greater portion of the stimulus to the muscles and blood- 
vessels of the lower spine. Dry briskly with a coarse towel 
and the patient is ready to dress. 

These external methods closely resemble each other in prin- 
ciple of action and may be selected according to the conveni- 
ence of the operator or his apparatus, although in certain cases 
the physician may discover therapeutic reasons for preferring 
one of the three currents. As regards indications, duration 
and frequency of treatment and clinical results there is not 
much choice between the methods. They are only suited to 
cases of the simplest form which require only a functional 
stimulation and which are not associated with actual uterine 
disease. 

Internal local methods. — Vaginal. — Faradic. — In simple 
primary amenorrhcea, when internal local treatment is ap- 
proved and desirable, a variety of methods are available. In 
virgins all possible injury to the introitus vaginae is avoided 
by omitting the use of a speculum. The faradic current never 
requires the assistance of a speculum for the insertion of an 
electrode when it is employed (as it usually is) without invad- 
ing the uterine cavity. 

Apply an ordinary sponge, or felt-covered, positive electrode 
to the nape of the neck with patient on operating chair, with 



282 TREATMENT OF MENSTRUAL DERANGEMENTS. 




Fig. 40. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

limbs flexed and knees apart. Insert a mono-polar bare metal 
vaginal electrode and maintain it in position by gentle pressure 
during treatment. Connect it with the negative pole of the 
high-tension induction apparatus and regulate a rapidly-inter- 
rupted No. 36 or No. 32 long coil current, up to full tolerance, 
which will be governed by the varying sensitiveness of the 



NEGATIVE. 

Fig. 41. Vaginal electrode insulated transversely with hard rubber. 



tissues, and differs in different patients and in the same patient 
at different times. 

Continue the application from five to ten minutes. 

If no pain has been present and full stimulation is indicated, 
shut off the maximum current abruptly at the close of the 
sitting. 

If sedation is indicated by local sensitiveness, reduce the cur- 
rent to zero very gradually. The necessary smooth and even 
increase of current strength in regulating the dose must be 
secured with the aid of the rheostat. 

Repeat three times a week until improved, and then once a 
week between periods, with two daily applications just previous 
to the expected flow. 



TREATMENT OF MENSTRUAL DERANGEMENTS. 283 

he vaginal bipolar electrode may be used in some of these 
s and possesses the advantage of greater facility, but is less 
;tive in determining a circulatory stimulation through the 
sr blood-vesssls. 
itra-uterine. — Galvanic. — When the experienced physi- 



l^s 


s 


^ 


^^^^ 


^^^ 


^©w 





%2. Fine felt or sponge-covered electrode — assorted sizes with soft rubber 
insulating backs. 

is certain that an intra-uterine application is "indicated, 
rative and electrolytic actions require the galvanic current. 
; influence of the negative pole will render the canal patulous, 
lulate the blood supply of the uterus and entire pelvic cir- 
tion, and set up the alterative and nutritional changes 
:ribed in the chapter upon Electro-physiology, 
lace a positive, felt-covered, flat electrode 4 X 8 on the cer- 



^ 



Fig. 43. Intra-uterine tips for negative pole. 

1 spine with the patient in the dorsal position on the operat- 
chair. Cleanse the parts sufficiently with either a vaginal 
che or careful swabbing, and engage and expose the Os 
I a speculum. Sterilize and insert a negative intra-uterine 
trode-sound of a .size suited to the canal, and pass it grad- 
Y into the uterus under the action of five or seven mil. of 
itant galvanic current if the Os is not patulous and if the 



284 TREATMENT OF MENSTRUAL DERANGEMENTS. 

electrode does not freely enter without the aid of the current. 
(See Stenosis.) 

When fully inserted gradually increase the dose through the 
rheostat to 15, and finally to 20 mil., holding the maximum 
amperage for about five minutes. Gradually reduce the cur- 
rent to zero. Entire stance, ten minutes. 

If decided stimulation and muscular contraction of the uterus 
is indicated, switch the automatic rheotome into circuit after 
the constant current application is reduced to zero. Adjust 




Fig. 44. One form of galvanic interrupter. Adj ust rate by shifting the ball. 

the rheotome to a slow rate of about 100 interruptions per 
minute and again raise the dose to a current strength which will 
set up painless but vigorous contractions. In three minutes 
reduce to zero and close the sitting. 

Applications of this character may be made twice or three 
times a week, either regularly during the interval between two 
periods, or during only the week of the expected flow. As- 
sociated conditions will guide the judgment of the operator in 
the treatment of each case and the duration of treatment will 
be determined by the results 

In Amenorrhoea existing as a symptom of ancemia or con- 
stitutional debility, or as a conservative process of nature in 
cachexias and exhausting diseases, do not employ intra-uterine 
electrodes. Improve nutrition in general and employ static or 
faradic stimulation to the spine, or percutaneous galvanism, as 
directed in this chapter. 
In Amenorrhoea associated with general plethora, local conges- 



TREATMENT OF MENSTRUAL DERANGEMENTS. 



285 



tion and the opposite .of the anaemic state employ intra-uterine 
negative galvanism if no active inflammation is present. 

Amenorrhoea due to chronic degenerative changes of the 
lining membrane of the uterus resulting in an atrophic state. 

Galvanic. — Place a positive, felt-covered, flat electrode, 
6X9, under the lumbo-sacral spine. Insert a negative intra- 
uterine electrode-sound to the fundus of the uterus with the 
usual antisepetic precautions. Gradually increase the constant 
galvanic current from zero up to 20 mil. at first, and as toler- 




Fig. 45. Fine felt or sponge covered electrode — assorted sizes witli soft rubber 

insulating backs. 



Fig. 46. Intra-uterine electrode. 

ance increases carry the dosage in subsequent treatment up to 
30, 40, or 50 mil. Always keep within comfortable tolerance 
and be alert to detect and avoid irritation. . 

Apply the maximum current for about five minutes and 
gradually reduce to zero. Total length of sitting, ten minutes. 
Repeat twice a week for several periods, until satisfactory 
results are established. 



Clinical Remarks. — In the majority of women hygienic 
treatment combined with ferruginous tonics and saline laxa- 
tives will bring on the periods in from four to eight weeks. 
This treatment, which is very effective in anaemic patients, is 



286 TREATMENT OF MENSTRUAL DERANGEMENTS. 

not so effective iti married women who are very stout. Fortu- 
nately in their case we have a valuable means of developing the 
uterus and appendages by causing a greater flow towards them, 
and that is the high tension faradic current applied with the 
bipolar intra-uterine electrode. I have had a great many such 
cases, principally in sterile women who have been married three 
or four years, and who while having no periods are becoming 
stouter and stouter. After from four to twenty applications of 
bipolar faradization the menstruation has almost invariably been 
re-established, and afterwards the amount can be made to in- 
crease by continued applications of the faradic current. {Smith) 

Never begin the treatment of any case of disordered menstrua- 
tion without first regulating the action of the bowels, or at least 
making an attempt to correct chronic constipation. Never make 
any vaginal bipolar faradic application with an accumulation of 
fceces in the rectum. Attention to simple details of this charac- 
ter is as indispensable to successful electro-therapeutic work as 
is the electrical apparatus itself. 

Amenorrhoea from Deficient Uterine Development. — In 

these I have employed the long, fine secondary faradic current 
with the most satisfactory results, in some cases the flow 
becoming firmly established after two or three applications, 
although in the majority it required two or three applications a 
week for two or three months. In two or three cases in which 
amenorrhoea was due to an infantile state of the genital organs 
a longer time was required, but I am satisfied that the most 
pronounced case can have her uterus so powerfully stimulated 
by means of the uterine bipolar faradization that eventually 
it will attain a depth of two and one-half inches, and other 
conditions being favorable she will conceive and bear children. 
{Smith.) 

Amenorrhoea Following Surgical Operations.— In these 
cases in which the function of the uterus is arrested, and par- 
ticularly when atrophy appears to be in progress, the patient 
should be treated with intra-uterine bipolar faradic stimula- 
tion repeated three times a week until results are obtained. 

Method. — In both the above cases the technique is the 
same. Carefully cleanse the cervical canal and the intra-uterine 
bipolar electrode. Connect the tip end to the positive pole and 



TREATMENT OF MENSTRUAL DERANGEMENTS. 287 

the negative to the inner half. Insert it to the fundus of the 
uterus. Switch into circuit the rapid interrupter and four or 
five cells. Regulate the current from zero until it is comfortably 





Fig. 47. Intra-uterine bipolar electrode. (Faradic.) 



felt. In ten minutes reduce to zero and switch to the slow 
vibrator regulated to about 80 periods per minute. Again 
increase the current strength until strong, agreeable contrac- 
tions are set up. In three or four minutes reduce to zero and 
remove the electrode. Repeat every second day. 

Diminished Menstruation in plethoric women with tendency 
to adipose deposit and indications for restoration of free and 
full flow. 

In these cases the selection and alternation of methods will 
easily be determined by experience with individual patients. 
If three treatments per week are given, two of them may ad- 
vantageously be vaginal bipolar faradic stimulation, and the 
alternate method may be intra-uterine negative electrolysis 
with the positive electrode over the lumbar region ; or, in cases 
especially marked by abdominal adipose formation, the bipolar 
method should be omitted and percutaneous galvanism sub- 
stituted instead. Place the negative electrode upon the lower ' 
abdomen, with the positive under the lumbo-sacral spine, and 
apply both constant and interrupted current in the usual 
manner. 

The tendency of the treatment will be to re-establish free 
drainage and flow, improve the general nutrition and limit the 
increase of fat, and in some cases bring about a considerable 
reduction. Treatment may be continued until benefit ceases. 
Three or four months' time will usually be required to establish 
lasting results. 
Scanty and Irregular Menstruation.^The^^«^r«/ con^ 



288 TREATMENT OF MENSTRUAL DERANGEMENTS. 

dition of the patient being taken into account, and no in- 
flammatory lesion contra-indicating the local application of 
an intra-uterine electrode, a mild negative galvanic cur- 
rent administered once a week, with vaginal bipolar faradi- 
zation twice weekly, will aid to restore a healthy uterine 
state. 

Menstrual Apathy following shock to the system, or mis- 
carriage. 

Galvanic. — Place a positive, felt-covered, flat electrode, 6X9, 
under the lumbo-sacral spine. Insert a negative electrode- 
sound to the fundus of the uterus. Increase the constant gal- 




Fig. 48. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 




NEGATIVE. 

Fig. 49. Intra-uterine tips for negative pole. 

vanic current through the rheostat from zero up to 20 mil., 
and maintain the maximum for five minutes. Gradually re- 
duce to zero, switch the interrupter into circuit and again in- 
crease the current strength sufficiently to cause comfortable 
contractions. In three minutes more close the sitting. Re- 
peat twice before each period, with two days between the 



TREATMENT OF MENSTRUAL DERANGEMENTS. 



289 



plications. Continue treatment until the normal function is 
ablished. Much assistance may be derived from the general 
lie affects of static electrification administered regularly 
2ry day or every second day for a few weeks. 
Simple Delayed Menstruation.— Ga/z/awzV.— Place a posi- 
e felt-covered, flat electrode, 6 X 9, on the lower abdomen, 
under the cervical or lumbar spine, according to convenience 
indications of the case. Pass a medium-sized, negative, 
;ra-uterine electrode-sound to the fundus of the uterus. In- 




, 50, Fine felt or sponge covered electrode — assorted sizes with soft rubber 
insulating backs, 




Fig. S'- Intra-uterine electrode — assorted size tips. 



:ase the constant galvanic current through the rheostat from 
•o up to 20 or 30 mil., according to tolerance. Maintain 
: maximum dose for five minutes and gradually reduce to 
o. Total length of sitting ten minutes. Repeat two or 
ee times if nece.ssary with an interval of two days between 
:h application. 
19 



290 TREATMENT OF MENSTRUAL DERANGEMENTS. 

Faradic. — Place a positive, felt-covered, flat electrode, 6X9, 
upon the lower abdomen. The vaginal electrode may be either 
mono-polar as shown in fig. below, or the usual bipolar elec- 



NEGATIVH. 



Fig. 52. Vaginal electrode insulated transversely with hard rubber. 

trode may be used by connecting the tip alone with the nega- 
tive pole. Connect the selected electrode with the negative 
pole of the high-tension induction coil, apparatus. Switch 
into circuit the 800 yard No. 32 wire coil, the rapid vibrator 
and four or five cells. Regulate the current strength to comfort- 
able tolerance with one-fourth of the resistance of the primary 
rheostat remaining in. If the tissues are insensitive to the 
long No. 32 coil, switch to a shorter and coarser coil till suffi- 
cient effect is produced. 

Quickly slide the contact piece of the primary rheostat so 
that it will cut out sufficient resistance to cause a powerful 
increase of the rapidly interrupted current and produce a wave- 
like contraction of the parts — which is immediately relaxed by 
at once shifting the rheostat to restore the previous resistance. 
Repeat this manoeuvre at intervals of a few seconds for about 
five minutes. If skilfully done the powerful stimulation pro- 
duced in this way will be in no degree painful or unpleasant. It 
possesses the advantages of being devoid of danger and of re- 
quiring no invasion of the uterine cavity. 

Static— \x\.yovir\^ girls during the period when menstruation 
is becoming established and requires some aid, in women ap- 
proaching the menopause, and in other cases where but little 
more is needed than a stimulus to the circulatory and nervous 
forces, and when exposure for local applications is refused, the 
application of static sparks is often effective, and was at one 



TREATMENT OF MENSTRUAL DERANGEMENTS. 29I 

time the only means employed in electro-therapeutics for this 
purpose. 

Stand the patient, fully clothed, upon the static platform 
connected with the negative pole. Ground the positive pole 
and the brass ball electrode. Apply strong, single, thick sparks 
upon the spine and over the lower abdomen with particular 
attention to the lumbar and ovarian regions. Do not apply 
the sparks too rapidly for the comfort of the patient, but con- 
tinue them for about five minutes, with necessary intervals of 
relief. 

In some cases the desired result is produced shortly, or with- 
in a day, and a single application once a month is satisfactory 
until no longer needed. It may be repeated daily for several 
days previous to the expected flow if such repetition proves to 
be necessary. It is a method free from all possibility of harm, 
but must, of course, give place to other methods whenever the 
sparks annoy a patient whose nervous tissues are in a hyper- 
sensitive state. 

Remarks. — In all the foregoing directions it is understood 
that precautions against sepsis are to be observed, and that no 
intra-uterine treatment should ever be given unless proper in- 
dications exist. Nearly all the liabilities of harm from the 
manifold uses of electric currents in gynecology relate to intra- 
uterine interference. In a large number of cases this is not 
necessary, and prudence in approaching the necessity (when it 
exists) is advisable. 

I am accustomed to sterilize bare metal electrode-sounds by 
dipping them in alcohol at the last moment and burning off 
the surface ; or they may be passed through the flame of an 
alcohol lamp. This method is very simple and seems sufifi- 
ciently satisfactory. 

All galvanic protected electrodes in these cases must be 
moistened in, a solution of bicarbonate of soda and hot water, 
and pressed Just dry enough to avoid dripping when in situ. 
Faradic external electrodes covered with felt or sponge may 
"be moistened in plain warm water. With either current the 



292 TREATMENT OF MENSTRUAL DERANGEMENTS. 

moistened electrode should be applied to the skin as hot as 
comfort will permit. After the electrode is removed the skin 
should be dried and dusted with toilet powder before the 
patient replaces her clothing. 

It is needless to say to any physician who possesses more 
than a tyro's knowledge of the influence of galvanic and faradic 
currents upon local and general nutrition and upon nerve and 
muscle function that the methods above described will not 
only correct the amenorrhoea, but will produce happy and 
beneficial effects upon the pelvic structures in general, and 
often upon the general health. The relief of pain which may 
have accompanied the menstrual derangement will be among 
the marked advantages which the patient derives from elec- 
tricity. 



CHAPTER XVII. 

TREATMENT OF MENSTRUAL DERANGEMENTS. 

Menorrhagia. Passive hemorrhagic states of the uterus. Metallic-electrolysis in 
hemorrhage. Remarks on bleeding states of the uterus. A beginner's expe- 
rience with post-partum hemorrhage. Fcetid menstruation and foetid leucor- 
rhoeal discharges. Static electricity and menstruation in general. Cervical 
and lumbar backache of women. Gynecological wrecks. The menopause. 
Premature menopause. Puberty. 

Menorrhagia. — In its simplest form this condition is cor- 
rected readily by tonic applications of electricity aided by 
medication directed to the anaemia, atony or other constitu- 
tional dyscrasia on which profuse periods may depend. 

Percutaneous galvanism and vaginal bipolar faradization are 
the two extra-uterine methods of electrical application. The 
one selected as most appropriate for a given case should be 
applied three times a week between the periods, and the gal- 
vanic method may be employed with benefit, and without 
objection, during the actual flow, after it has continued a suffi- 
cient time and does not cease. Instructions for employing 
these methods are given elsewhere. (See INDEX.) 

Hemorrhagic States of the Uterus. — When the bleeding is 
not active and does not demand operative interference. 

Galvanic. — Place a felt-covered, negative electrode, 7 X 10, 
on the lower abdomen. Insert a positive platinum electrode- 
sound in the uterus so that it will make contact with the entire 
canal. If this is not possible (either from lack of such an elec- 
trode, or from the shape and size of the canal) a zinc-amalgam 
tip electrode may be employed and the surface treated in 
sections. 

Gradually increase the constant galvanic current from zero 

up to full tolerance. Maintain the maximum current for five 

293 



294 



TREATMENT OF MENSTRUAL DERANGEMENTS. 



minutes and reduce to zero. Repeat on the second day and 
until the oozing is controlled. 




Fig. S3. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 



Fig. 54. Intra-uterine electrode, platinum stem, two and a half inches long. 

Size, No. II, French. 




Fig. 55. Set of copper or zinc bulbs. 




Handle for same. 

At the first stance the amperage may reach full tolerance 
at only 40 or 50 mil., but as active chemical cauterization is 
required to control the bleeding vessels the dose must be 
pushed at each sitting until the effect is secured. From 80 
to 100 mil. may be thus attained in a few sittings and will be 
effective in most cases. 

If more current is required than the area of the external 
electrode will handle with comfort, place a similar pad under 



TREATMENT OF MENSTRUAL DERANGEMENTS. 205 

the sacrum and connect both the external electrodes to the 
negative pole by a bifurcated cord. 

The electrode must be held motionless during the application 
so that continuous contact between the metallic or carbon sur- 
face and the tissues is maintained until the bleeding vessels 
are thoroughly cauterized. 

After the bleeding is apparently controlled the case should 
be treated once a week with a milder current until normal 
conditions are established. 

This method involves only the cauterizing action of the 
positive galvanic current with a non-attackable electrode and 
high amperage. The alternate method utilizes the astringent 
and hemostatic properties of metallic electrolysis, and in un- 
complicated uterine hemorrhage may be given preference. In 
many cases it is superior to the galvanic current alone, and 
requires much less amperage. 

Metallic Electrolysis in Hemorrhage.— The external nega- 
tive electrode is the same as above. The positive intra-uterine 
electrode must be selected from the set of copper tips or 
sounds according to the size of the canal. It should be as 
large as will readily enter. 





Fig. 56. Zinc and copper tips for metallic electrolysis. 

Increase the constant current strength through the rheostat 
from zero up to 20 mil., and after two minutes increase to 30 
mil. Maintain the maximum current for from five to ten 
minutes according to the intensity of action required. The 
largest electrode will have more current capacity than smaller 
sizes, and this must be taken into account in regulating the 



296 TREATMENT OF MENSTRUAL DERANGEMENTS. 

dose. The longer the application the more oxychloride of 
copper will be deposited in the tissues, and an excess will cause 
colic a little later. Practice will teach the art of securing the 
desired effect without an excess of current. 

Hold the electrode motionless during the application. It. 
will become adherent to the tissues. Do not free it by force. 
Reduce the current to zero, reverse the polarity and pass a 
mild negative current of about 7 mil. until it loosens itself and 
slips readily out of the uterus. 

The hemostatic action of cupric, zinc, or zinc-amalgam, 
electrolysis " will often control the bleeding when every other 
means has failed, " but it is sometimes followed by a few colicky 
pains and occasionally by a primary aggravation of the hemor- 
rhage, which is not an evidence of failure. It may be due to 
conditions which the treatment was too late to control, and 
may in part be due to the use of the negative pole in loosening 
the electrode. If permanent improvement is not observable 
at the first period it may be marked at the second, and the final 
result be perfectly satisfactory. 

Before and after all intra-uterine applications in bleeding 
states the parts should be cleansed and a tampon of iodoform 
gauze placed around the cervix immediately after the with- 
drawal of the electrode. 

Metallic electrolysis is antiseptic per se and involves no 
danger of sepsis. 

The electrode, whether copper or zinc, must always be 
brightly polished with OO emery paper at the moment of insert- 
ing it in the uterus, and needs no sterilizing except upon the 
insulating handle which occupies the cervix. 

Metallic electrolysis is a method which acts with few repeti- 
tions. It should be repeated only when the indications call 
for it, and only after the lapse of sufficient time to demonstrate 
the results of the first treatment. 

Remarks. — For controlling obstinate and severe forms of 
uterine hemorrhage the coagulating and hemostatic action of 
the positive galvanic current is remarkably effective when 



TREATMENT OF MENSTRUAL DERANGEMENTS. 297 

it can be properly applied. It does not take the place of the 
curette when clots and large portions of the placenta are 
retained after miscarriage, and if for any reason the lining of 
the uterine canal will not make free contact with the surface 
of the electrode the current will fail to cauterize the tissues 
and stop the bleeding unless the interference is removed. 

In extreme hyperaesthetic states some partial anaesthesia 
will (in rare cases) be necessary to render rapid cauterization 
with a current of high intensity possible at the first sitting, 
when urgency and active bleeding demands it. A few occa- 
sional whiffs of chloroform as administered in obstetrics will 
answer the purpose. 

Rest in bed, hygienic precautions and accessory medical 
treatment are to be considered by the attending physician 
according to the indications of each case. At all times the 
action of electricity should be supported by the best judgment 
of the practitioner and not simply left to chance for its effects. 

It is obvious that some cases may be treated at the office, 
but that severe cases can only be treated in the house or 
hospital. 

If bleeding persists after curettage for any of the conditions 
which demand it, the positive galvanic cauterization or metallic 
electrolysis will aid greatly to shorten the enforced rest in bed 
and hasten convalescence. When the patient is able to be 
about and continue treatment at the office, the full return of 
strength and health will be admirably promoted by static 
electrification and also by percutaneous galvanism or by the 
vaginal bipolar method. 

Remarks on Bleeding States of the Uterus. — In profuse 
menstruation electricity finds perhaps its greatest usefulness. 
On this point at least I can speak from a considerable expe- 
rience. A common cause of menorrhagia is fungous endome- 
tritis. In this disease the uterus is large and heavy and the 
circulation in it is bad. This may be due. to faulty position, 
interference with the circulation, sub-involution after a miscar- 
riage, or a septic confinement with or without a laceration of 
the cervix. In cases of menorrhagia from these causes I have 



298 TREATMENT OF MENSTRUAL DERANGEMENTS. 

had most gratifying results with the continuous current, the 
positive pole in the uterus. We can be alniost certain in every 
case that the uterus will return to its normal depth and size 
after from five to twenty applications. 

By most writers fibroid tumors are considered among the 
principal causes of menorrhagia, but in my opinion they are 
merely a coincidence with the fungous endometritis, both 
being due to the same cause — obstructed circulation in the 
uterus. In hundreds of cases of profuse menstruation I have 
almost invariably seen the flow diminished merely by improv- 
ing the pelvic circulation, and very often with no other treat- 
ment than the cure of the constipation. 

Whatever may be the cause of the obstructed circulation the 
condition is generally the same. The close capillaries which 
supply the mucous membrane bleed profusely on the slightest 
injury This is the condition of the mucous mem- 
brane which gives to the uterine myomata their most charac- 
teristic symptom of hemorrhage. It is not the tumor but 
rather the condition of fungous endometritis which so often 
accompanies it, as well as the increased area from which the 
hemorrhage takes place when the cavity of the uterus is thus 
enlarged, which are the real causes of the bleeding. 

If now the spongy and exceedingly vascular endometrium 
be removed we shall have, instead of varicose veins which 
break and remain open, small arteries which immediately con- 
tract and close up when cut across or otherwise destroyed. 
The cleaning out of the uterus with a sharp curette has been 
found a useful temporary expedient for the arrest of hemor- 
rhage, but to be effective at all it is most essential that the 
curetting be followed by a caustic which will close up the 
open ends of the blood-vessels. 

The intra-uterine application of the positive pole of the con- 
tinuous galvanic current of sufficient strength produces precisely 
this effect, and, moreover, the mere fact of passing a strong 
current through the electrode renders it aseptic and therefore 
perfectly safe. Moreover the interpolar action of the current 
exerts a powerful influence upon the trophic nerves which the 
sharp currette does not, and this is another advantage in favor 
of electricity. 

In several cases of metrorrhagia due to suspected com- 
mencing cancer of the uterus, in women who have passed the 
menopause and begun to flow again, I have arrested the bleed- 
ing with positive galvanization so that it has not returned. 

.... I only mention this case as one illustrating the 
almost infallible power of the positive galvanic current to arrest 
the severest forms of hemorrhage. 



TREATMENT OF MENSTRUAL DERANGEMENTS. 299 

As for cases of menorrhagia due to chronic endometritis, 
with or without fibroids, I have never known it to absohitely 
fail ; and even one case which I reported some time ago as a 
failure called to see me the other day to say that the frightful 
hemorrhages had never returned, that she had gained in flesh 
and weight and felt altogether so well that she had ventured 
to get married. Even in her case — one of fibroid — in which I 
was prevented from using full doses on account of the tender- 
ness of the appendages, the latter had been so much benefited 
that menstruation is now almost entirely free from pain. 

But as I have already said there are so many cases reported 
of menorrhagia having been cured by intra-uterine galvanic 
treatment that they alone would fill many volumes. That this 
treatment will cure menorrhagia almost with certainty. is one 
of the best established facts in therapeutics. {Smithy 

The following account of a triumph over uterine hemorrhage 
is told with a directness which will convey a practical lesson to 
the general practitioner : 

When a mere lad my preceptor sent me to attend a charity 
obstetrical case. My knowledge of the anatomy of the female 
pelvis was of the most rudimentary character, as was also my 
knowledge of the obstetric art. Fortunately the baby was 
soon born, and I immediately became concerned about the 
delivery of the placenta. While groping around in the dark 
with my fingers I chanced upon a labia minoria which was 
hypertrophied after the fashion of the Hottentot. I forthwith 
began to pull upon the labia thinking it was the placenta. 
Simultaneously the woman commenced to shriek. With the 
calm dignity I had seen my preceptor exhibit toward nervous 
females, I remarked, " Be quiet, my good woman, I am only 
delivering the afterbirth. " " Afterbirth ? you fool, " she 
yelled, in utter disregard of the rules of grammar, " it's me 
you are pulling on." A strong, after-pain came to my relief at 
this moment and the placenta was expelled, but with it came 
a stream of blood the equal of which I have never seen since 
in a practice of fourteen years. 

I had read about posf-partum hemorrhage and knew the 
routine treatment. I kneaded the womb with the left hand 
and turned out the clot with the right, injected hot water and 
vinegar, and -poured ice water on the abdomen from a height, 
but all to no purpose. The uterus would contract until no 
lariger than a cocoanut, then relax, accompanied with a gush of 
blood that was truly terrific. 



300 TREATMENT OF MENSTRUAL DERANGEMENTS. 

My patient was growing cold and pulse weakening, and I 
saw that unless reinforcements arrived the battle was lost. I 
hastily sent for my preceptor, and while impatiently waiting 
for his arrival I fully appreciated the heartrending agony of 
WeUington's " Would that' Blucher would come ! " Luck was 
with me that day, as it was with Wellington, for my Blucher, 
in the person of my preceptor, soon arrived, armed with per- 
chloride of iron and an overdose of contempt for his student 
who could not control an ordinary case of post-partum bleed- 
ing ; but he soon discovered that this was no ordinary case, 
and he applied his styptics in vain. The uterus refused to 
contract and there was complete inertia. 

Finally, a happy thought, we sent to the ofifice for a faradic 
battery, applied one pole to the uterus and the other over the 
abdomen, turned on the full current, and, presto ! — the inertia 
was a thing of the past, the uterus contracted to the size of an 
orange and stayed there, the hemorrhage ceased, and my 
Waterloo ended in a victory. 

Several years ago I received an urgent message to attend a 
lady who was "flooding to death." Upon my arrival I found 
my patient pale and almost fainting from loss of blood. She 
was aged forty-five and passing the climateric ; was the mother 
of eight children, and had had three miscarriages in the past 
two years. The uterus measured five inches. I prescribed the 
indicated remedy and douches of hot water and vinegar. 
Called again in four hours and found the patient no better. I 
then packed the vagina thoroughly ; this controlled the hem- 
orrhage, but it would recur whenever the packing was re- 
moved. Recalling my first obstetrical case I used my faradic 
battery as strong as the patient could stand it. The hemor- 
rhage stopped at once and the woman has not menstruated 
but a few times since, and each time normally. 

I attended a lady recently in her fourth confinement. I had 
attended her in her previous confinements and she had always 
flooded considerably, so I went armed this time with the bat- 
tery, and it is well I did, for following delivery of placenta she 
had veritable /^j/-/«r/z<;« hemorrhage. I immediately applied 
the battery, withotit other treatment, the uterus promptly 
contracted, and the hemorrhage ceased. After waiting a short 
time and the hemorrhage not recurring I went home to dinner. 
In the course of an hour a messenger came for me stating the 
patient was suffering great pain. I hastily returned and found 
the woman apparently again in the throes of labor. After 
several severe pains she expelled a round solid clot of blood 
the size of a cocoanut. The uterus had contracted instantane- 



TREATMENT OF MENSTRUAL DERANGEMENTS. 



301 



ously on application of the electricity and the blood had not 
had time to escape. 

I have now a patient under treatment for large interstitial 
uterine fibroid. I used galvanism for several months three 
times a week, giving from fifty to seventy-five milliamperes at 
each treatment, but it failed completely to stop the hemor- 
rhage. I then tried faradism and found to my surprise that it 
moderated the hemorrhage to a marked degree. This patient 
bought herself a faradic battery and uses it as soon as men- 
struation begins, and while formerly she flowed for ten weeks, 
since using the battery she never flows more than four days, 
and only moderately at that. 

I could recite many more cases of the same character, but 
these are sufficient to show that faradism is a remedy we can- 
not afford to overlook in uterine hemorrhage. {Daily.) 



The faradic current is indicated in all hemorrhages from the 
uterus due to relaxation of muscular fibre, in the hemorrhages 
attendant on subinvolution,in/o.y/-/«r^M»« hemorrhages, and to 
some extent in hemorrhages of fibroids. 

One of the simplest and most commonplace illustrations of 
the usefulness of the galvanic current in ofifice practice in cases 
of metrorrhagia is the following : 

Mrs. , aged 35, probably aborted two months previously, 

although she denied it. Has been unwell ever since. 

Treatment. — A cleansing vaginal douche. Negative felt- 
covered, flat electrode, 7 X 10, on abdomen. Positive intra- 




Fig. 57. Fine felt or sponge covered electrode-!-assorted sizes with soft rubber 

insulating backs. 



302 TREATMENT OF MENSTRUAL DERANGEMENTS. 



Fig. 581 Intra-uterine electrode, platinum stem, two and a half Inches long. 
Size, 'No. II, French. 

uterine platinum-sound electrode. Thirty mil. constant gal- 
vanic current for ten minutes. Three days later repeated with 
50 mil. 

Report from first application : " Flow has been reduced to 
a mere show. My pain has been much easier and in every 
way I feel a great deal better. 

The second application stopped the remainder of the 
flow. 

Foetid Menstruation and Foetid Leucorrhoeal Dis- 
charges. — Galvanic. — Perhaps the best aid electricity affords 
to supplement other local and constitutional measures consists 
of zinc-amalgam electrolysis. 

. Place a felt-covered, fiat electrode, 7 X 10, on the lower 
abdomen and connect it with the negative pole. Freshly 
amalgamate an intra-uterine zinc electrode-sound, adapted to 
the size of the cavity, and insert it to the fundus of the 
uterus. Gradually increase the constant galvanic current from 
zero up to full tolerance, which will vary from thirty to sixty 
milliamperes. Begin with the smaller dosage in early sittings 




Fig. 59. Fine felt or sponge covered electrode— assorted sizes with soft rubber 

insulating backs. 



TREATMENT OF MENSTRUAL DERANGEMENTS. 303 




Fig. 60. Five electrodes : insulated with soft rubber tubing to expose any de- 
sired surface. 

and increase the current as the tolerance of the tissues devel- 
ops during the progress of improvement. 

Duration of sitting from five to ten minutes, repeated twice 
a week. 

If the condition returns after a few applications of this anti- 
septic current the cause of failure should carefully be sought 
and treatment modified accordingly. 

Static Electricity and Menstruation in General. — When 
patients are undergoing a course of treatment by static electric- 
ity for some chronic affection, perhaps entirely disassociated 
from any pelvic cause, they may ask if treatment should be 
stopped during menstruation. Static sparks are usually not 
well borne at such a time, and practised operators make it a 
rule to omit them ; but as the mild head breeze and simple 
electrification are not only peculiarly grateful to menstruating 
women, but afford relief to much of the irritability or even 
dysmenorrhcea which arises chiefly from ill health, it is bene- 
ficial and desirable to continue modified treatment during the 
period. 

As no disrobing or exposure of the patient is required in 
static electrification, questions of delicacy do not enter into the 
consideration of the case. 

Cervical and Lumbar Backaches of Women.— If there is 
in the whole range of medicine an unfailing balm to the 



304 TREATMENT OF MENSTRUAL DERANGEMENTS. 

woman whose back feels as if it would " break in two," it is the 
electrical current generated by the Holtz apparatus. 

Whether the ache is high up or low down, is mild or severe, 
is recent or old, is superficial or deep, is sore and tender to 
touch so that she can hardly wear her clothes, or is of the 
opposite character, I want no other remedy than electricity in 
some form. 

The first, simplest, and unfailing remedy for recent pains of 
congestion or fatigue is the static breeze. To older and more 
obstinate cases add the mild spark or counter-irritation. 

There are few women who do not have backaches at some 
time. There are still fewer women who cannot obtain prompt 
and efficacious relief from selected forms of electrical applica- 
tions. If the breeze and spark fail to do well in an inveterate 
and deep-seated case there it still left among the resources of 
the static machine the rapidly interrupted high-potential small 
Leyden-jar current which will handle the remainder of the' 
cases. 

Gynecological Wrecks. — Some years ago women encoun- 
tered a panacea for the cure of their infirmities of whatever 
sort, from neuralgia to epilepsy. The result has put into our 
hands an army of women without ovaries, but with a nervous 
system with an unimpaired capacity for getting sick and feeling 
miserable. The reflex symptoms of disturbance are often 
about as great as they had been before the cause (?) was 
removed. 

It is a thankless task, well-nigh beyond the powers of safe 
remedies, to follow these neurotic symptoms and give satisfac- 
tory relief. Drugs which are cruelly deceptive in their pallia- 
tion of neuroses are too often injurious in ultimate effects to 
be long continued. Between bipolar faradization and static 
electricity relief can be afforded to patients of this kind who 
would otherwise drift hopelessly along in a pitiful and despond- 
ing state. 

The Menopause. — To one who has never personally wit- 
nessed the benefits bestowed upon women during the neurotic 



TREATMENT OF MENSTRUAL DERANGEMENTS. 3OS 

disturbances of the menopause the verbal recital of the action 
of static electricity upon this state would seem like gross ex- 
aggeration. It is a " state of disordered function," and every 
physician should carefully read the physiological action of 
static electricity upon functional derangements of the system. 
There will then be no occasion to charge any one with extrav- 
agance in reporting his clinical experience. 

The general depression of the system caused by an attempt 
to subdue the neuroses of the menopause by the prolonged 
administration of bromides is an opprobrium upon scientific 
medicine, and the attempt to select remedies upon sympto- 
matic indications often keeps both the physician and patient 
busy. 

In many cases, however, the unfortunate woman either 
thinks that nothing can be done for her relief (and she accord- 
ingly endures her condition with what fortitude she can), or 
else her doctor prescribes a palliative and advises her that time 
alone will bring her permanent relief. 

The fact should certainly be known to every member of the 
medical profession that this class of cases is distinctly within 
the chief sphere of action of sedative-tonic and function-regu- 
lating static electricity. 

It is at this time of life again that mild static sparks around 
the pelvis have an effectual influence in regulating the declin- 
ing menstrual function, just as they efifectively regulated the 
commencing activity in puberty. 

To recite the other capabilities of the different forms of ap- 
plication would be to narrate in detail every nervous, muscular, 
and functional disturbance of this period of a woman's life ; 
for static electricity will relieve them all, will direct into nor- 
mal channels of action the unsettled activities of sympathetic 
and cerebro-spinal nerves, and conduct the woman through and 
out of the season of the climacteric in a rational and satisfac- 
tory way. 

To the operator who understands the management of his 

apparatus, the Holtz machine dispenses at once with many 
20 



306 TREATMENT OF MENSTRUAL DERANGEMENTS. 

other agents of the materia medica for the functional derange, 
ments of this stage of life, and not only surpasses them singly 
but collectively in value. 

Even for the troublesome menopause, for which the laparo- 
tomist can offer no relief, the conservative gynecologist has in 
the fine wire induction coil current applied to the uterus or 
even to the vagina with the bipolar electrode a most effective 
means of drawing the attention of the nervous system back to 
the pelvis and away from the brain. Bipolar intra-uterine 
faradization with a medium coil causes a flow of nervous energy 
and sometimes of blood which makes a very fair substitute for 
the menstrual flow. {Smithy 

The chief applications of faradic and galvanic currents in this 
condition are two, viz., bipolar faradization and negative intra- 
uterine galvanic determination of blood to the uterus. The 
general methods of faradization are displaced by the simpler 
and more beneficial static applications. 

In the absence of other indications the technique of these 
methods follows the directions for amenorrhoea, and therefore 
need not be repeated in full. 

Premature Menopause. — In some cases the function can 
be restored by intra-uterine negative galvanism and tonic ap- 
plications of coil currents as already described in the treat- 
ment of amenorrhoea. Whenever it is necessary to divert the 
nervous energy, from the head to the pelvis the attempt should 
be made by these methods. 

Puberty. — It is self-evident to any one familiar with the 
physiological action of static electricity that when either girls 
or boys are maturing with tedious delay, and especially when 
they have just suffered from some prostrating acute illness and 
convalesce slowly, scarcely any other agent would do them 
an equal amount of good. We need not dwell on this point. 
It is simply a question of suiting the method to any given 
patient's needs. 



CHAPTER XVIII. 

TREATMENT OF DYSMENORRHCEA. 

Dysmenorrhoea due to endometritis. Dysmenorrlioea in young girls. So-called 
neuralgic, congestive, and ovarian types. Dysmenorrhcea complicated with 
uterine disease. Membranous dysmenorrhoea with profuse or scanty flow. 
Dysmenorrhoea with stenosis of the canal. Dysmenorrhoea with incomplete 
development of the uterus. Percutaneous galvanism in simple forms of 
dysmenorrhoea. Dysmenorrhoea due to inflamed ovaries and inflammation of 
the tubes. A discussion on dysmenorrhoea. Various methods of treatment. 

Dysmenorrhoea. — In many cases of dysmenorrhea there is 
a hyperaesthesia of the endometrium in the region of the inter- 
nal Os and in the fundus. The touch of a sound will cause a 
sharp pain, and similarly uterine contractions cause spasmodic 
dysmenorrhcea. 

The intra-uterine electrode application benumbs, alters, and 
restores to healthy nutrition the congested and irritable mucous 
membrane. The hyperaesthesia is removed, the vicious reflex 
contractions stop, and menstruation occurs thereafter without 
pain. " I have been," says Dr. A. L. Smith, " very much struck 
with this factor of spasm at the internal Os in my cases of 
fibroid tumor who came to me with their menstruation causing 
them the most fearful pain although there was no stenosis of 
the canal ; and yet after from ten to thirty applications of the 
galvanic current, generally the positive pole in the uterus, 
menstruation would come on absolutely without pain. More- 
over, notwithstanding that strong currents employed to dimin- 
ish fibroids have contracted in some cases the cervical canal to 
the point of actual stenosis, nevertheless menstruation came on 
absolutely without pain and several of these patients even 
became pregnant." 

For the treatment of endometritis and dysmenorrhcea there 

307 



3o8 TREATMENT OF DYSMENORRHCEA. 

is probably no better method or means than the intra-uterine 
application of the galvanic current. Endometritis is present 
in the majority of cases of dysmenorrhcea, and as a thousand 
or more skilled witnesses can be found in different parts of the 
world to testify from their own experience that intra-uteririe 
galvanic treatment cures endometritis, it becomes easy to_ 
explain the otherwise "almost miraculous results" of this 
treatment in dysmenorrhcea. 

Both the positive and negative pole have their clearly defined 
indications which are made familiar to the readers of these 
chapters. The positive galvanic current is almost an infal- 
lible remedy for dysmenorrhcea due to endometritis, while the 
negative pole is an equally valuable remedy to promote drain- 
age and to remove the mechanical obstruction of a stenosis. 
Those who employ proper electrical currents in the treatment 
of these conditions rarely feel the need of other procedures, 
and the routine of topical application becomes for the most part 
a historical reminiscence. 

Symptomatic. — When the cause of this symptom is uter- 
ine, i. e. an unhealthy uterus in any state which makes the pas- 
sage of the ovurn difificult and impairs drainage — stenosis of the 
canal, displacements, all the gradations of metritis and endo- 
metritis between congestion and an inflamed, hypertrophied 
and hyperaesthetic condition, a fibroid tumor, or whatever 
causes obstruction and produces endometritis, these manifold 
dysmenorrhoeas can generally be relieved by dilatation of the 
cervical canal and treatment of the endometritis by proper 
electrical methods, And a large percentage of symptomatic 
cures obtained. 

The negative galvanic current will always accomplish ade- 
quate dilatation except in the few cases in which the tor- 
tuosities of the canal, by a deforming tumor, prevent the in- 
sertion of an electrode, but the treatment of endometritis must 
follow an intelligent diagnosis of the condition present. 

By this is meant that endometritis /^r se cannot be treated 
by routine electricity, but that the selection of the positive or 



TREATMENT OF DYSMENORRHCEA. 309 

negative galvanic pole and dosage, and the auxiliary use of 
bipolar faradization must be made by the operator according 
to quite clearly defined indications laid down in the teachings 
of electro-physiology. Guided by these teachings the choice of 
pole is rarely in doubt. 

To avoid repetition, the treatment of dysmenorrhoea de- 
pendent on endometritis is partly reserved for the section 
devoted to that subject. 

Dysmenorrhoea in its simplest form in young girls, or 
chlorotic, neurotic, or any other cases, when local examination 
and treatment is undesirable or refused, and when the cause is 
not intra-uterine disease, may often be relieved during the 
acute pains, and curatively treated between periods, by one of 
two very valuable methods which involve no objectionable 
exposure. These methods are percutaneous galvanism and 
vaginal bipolar faradization applied according to the directions 
fully given under their separate heads. 

The usual classification of the varieties of dysmenorrhoea 
possesses very little practical value to the electro-therapeutist, 
and to a great extent the theoretical discussion and routine 
treatment of works upon gynecology which ignore electric 
currents must now be deemed as far in the rear of gynecological 
progress. 

Electricity is the sheet-anchor of conservative gynecology. 
If the case is a simple one the general health of the patient 
and the character of the flow will refer the physician to the 
proper treatment for either deficient or excessive menses, and 
separate treatment for the pain will rarely be required when 
either external or vaginal applications are indicated. The 
pain will be controlled when the condition which causes the 
pain is relieved by the electrical administrations. 

The bipolar method may be practically useful, either alone 
or as an adjunct to intra-uterine galvanism, in almost all cases 
of dysmenorrhoea which any non-surgical treatment will relieve 
or cure. It possesses no alterative electrolytic action upon a 
diseased mucous membrane, and therefore yields to galvanisi* 



3IO TREATMENT OF DYSMENORRHCEA. 

in chronic dysmenorrhoeas due to an unhealthy uterine state, 
stenosis of the canal, and obstructive conditions which impair 
drainage and demand the chemical current. These latter con- 
ditions are probably of far less importance than endometritis 
as a cause of dysmenorrhoea. 

Dysmenorrhoea of So-called Neuralgic, Congestive and 
Ovarian Types. — The main relief for these forms of dysmenor- 
rhoea is afforded by vaginal bipolar far adic sedation as described 



Fig. 6i. Bi-polar Vaginal Electrode. 

under that heading. It should be persistently and regularly 
applied at least three times a week between periods, and it 
should also be observed whether or not the uterine canal is patu- 
lous. Free drainage should be established by the negative 
galvanic current (see Stenosis), and we may then rely with con- 
fidence upon faradic sedation with a properly selected current. 

In no branch of therapeutic work does the improved high- 
efficiency induction coil apparatus present a greater contrast 
to the crude family battery than in the remarkable comfort, 
relief and almost invariable cure of these pelvic neuralgias 
and pains which so often formerly laid the foundation of the 
morphine habit or addiction to alcoholic stimulants. The 
uses of anodynes in gynecology may be immensely lessened 
by the substitution of curative bipolar faradic sedation for the 
pain-obtunders which only palliate the pain and tend to 
destroy health. 

Complicated Dysmenorrhoea, associated with intra-uterine 
neoplasms, pelvic deposits, flexions, malignant disease, and 
causes demanding treatment in chief, must be considered with 
reference to the complications. The aid that electrical currents 
can render to treat the condition and to relieve the pain is 
stated under each separate heading. 



TREATMENT OF DYSMENORRHCEA. 



311 



In many cases when the pathological lesion cannot be radi- 
cally cured the pain can be promptly relieved and often a symp- 
tomatic cure can be effected by electricity in cases which are 
otherwise hopeless. In cases which properly call for operative 
interference electricity well deserves to be regarded as the hand- 
maid of the surgeon — the indispensable instrument of con- 
servative precautions and post-operative aid to convalescents. 

So-called "Membranous" Dysmenorrhoea (Profuse flow). — 
Galvanic. — As soon as menstruation ceases for a given period 
attack the diseased lining of the uterus with the galvanic 
current. Should the cervical canal not be already patulous it 
must be dilated moderately with the usual negative current of 
ten to fifteen mil. (see STENOSIS). 

When this has been done apply a positive galvanic current 
to the entire uterine membrane from the internal Os to the 
fundus. The uterine electrode must be either platinum, or 
block tin, or carbon ; or in some cases zinc-amalgam may be 
used, but platinum is usually employed. 




Fig. 62. Zinc electrodes : insulated with soft rubber tubing to expose any de- 
sired surface. 



Fig. 63. Positive electrode with sliding shuttle. 

Take two felt-covered, 6X9, flat electrodes, moistened thor- 
oughly in hot soda-bicarbonate solution, and place one upon 
the lower abdomen and the other under the sacrum. Attach 



312 TREATMENT OF DYSMENORRHCEA. 

them to the negative pole by a bifurcated cord. The large 
area of contact thus secured will permit the use of large 
currents without discomfort. 

Insert an intra-uterine electrode of sufifiicient size to affect, 
with its metallic portion, the entire uterine lining. Increase 
the constant current through a rheostat from zero up to com- 
fortable tolerance at the first sitting, and, after maintaining 
the maximum for about five minutes, reduce to zero. As the 
tolerance will increase after each application the dose may be 
gradually pushed from 50 up to 100 mil. in the course of six or 
eight treatments. Repeat only once a week between periods. 
Inter-current bipolar sedation will be useful also. If pain 
results from the galvanic application at any time, the sitting 
may be closed with a few moments bipolar sedation, and if 
conditions permit regular bipolar tonic applications two or 
three times a week the patient will derive great" benefit. 

Duration of treatment may extend over three or four 
periods, or until sufificient relief is afforded. 

Membranous Dysmenorrhoea {Scanty flow). — For these 
cases in which after excruciating pain an entire cast of the 
uterine cavity is expelled the negative pole of the continuous 
galvanic current in the uterus has been found to be of the 
greatest benefit. The sittings should begin the week before 
the expected period and should be repeated every day or two, 
each sitting lasting ten minutes and a current strength of from 
50 to 100 mil. being employed. Rapid dilatation and curet- 
ting performed under the most rigorous aseptic conditions 
have long been advocated for the treatment of this painful 
affection, but the negative galvanic current does the same thing 
in a much more gentle way, requiring neither anaesthesia nor 
subsequent confinement to bed. {Smith.) 

Dysmenorrhoea of the form commonly due to congestion, 
recent endometritis, or some hypersensitive, unhealthy state 
of the lining membrane of the uterus. Always begin with 
vaginal bipolar faradic sedation and continue it alone until 
local tenderness is removed and a sound may be inserted with- 
out distress. The next step of treatment employs the constant 
current. 



TREATMENT OF DYSMENORRHCEA. 313 

Galvanic.—Aher a careful diagnosis of the condition and 
the exclusion of contra-indications, cleanse the vagina with the 
usual creolin douche and place on the lower abdomen a felt- 
covered, fiat electrode, 6X10. Sterilize the uterine-sound 




Fig. 64. Fine felt or sponge covered electrode— assorted sizes with soft rubber 

insulating backs. 



Fig. 65. Long tin tip intra-uterine electrode. 

electrode adapted to size of the canal. If the uterus is large, 
soft, and the menstrual flow has been profuse, the sound 
electrode should be connected with the positive galvanic pole. 
If the uterus is hard and the flow scanty or delayed make the 
sound negative. ^ 

Increase the continuous galvanic current through a rheostat 
from zero up to 20 mil. Maintain this strength for a moment 
and gradually increase to the point of comfortable tolerance, 
but rarely exceed 50 mil. in any case, for high intensities and 
cauterizing effects are not required in this condition. The 
current action is caXled galvano-caustic by some writers. 

About three minutes of maximum current action is suffi- 
cient. Reduce the current gradually to zero. Total length of 
sitting ten minutes. Insert a glycerine tampon if indicated. 

No rules as to rest in bed or restriction of habits are usually 
enforced during the progress of treatment by this method. A 
half-hour's rest immediately after the application of every 



314 TREATMENT OF DYSMENORRHCEA. 

intra-uterine galvanic current of over 40 mil. is desirable, but 
each patient is a law unto herself in this respect. 

If the intra-uterine electrode is positive it must be non- 



Fig. 66. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 

attackable (usually pure tin or platinum), a fact the operator 
should never forget. 

Repeat galvanic applications twice a week between several 
periods, each one of which will be more comfortable than the 
preceding if the method is properly carried out. 

Inter-current vaginal bipolar sedative-tonic applications may 
advantageously be given, and when general tenderness exists 
should always /r^f^d^^ the intra-uterine galvanism. So certain 
and unfailing are these combined methods in skilful hands 
that other procedures are seldom required, but the practi- 
tioner who is but little trained in electro-gynecology should 
advance with caution into the delicate regions of intra-uterine 
applications and the novice should never attempt them. Least 
of all should they be attempted without improved apparatus 
of the best type. Try percutaneous and extra-uterine 
methods first, even though they are less effective. 

Dysmenorrhoea with "Stenosis of the Internal Os." — 




Fig. 67. Fine felt or sponge covered electrode— assorted sizes with soft rubber 

insulating backs. 



TREATMENT OP DYSMENORRHCEA. 



315 




Fig. 68. Intra-uterine electrodes, assorted sizes. 




Handle for same. 



Galvanic. — Positive, felt-covered, flat electrode, 6X9, on lower 
abdomen ; negative intra-uterine sound. After sterilizing the 
canal and the sound as usual, insert the electrode as far as it 
will go, and increase the constant galvanic current from zero up 
to five or seven mil. Exert very gentle pressure. Simply 
support the electrode so that the tip rests against the con- 
stricted Os. In a moment or two sufficient dilatation will 
often take place to carry the electrode into the uterus. If this 
does not occur increase the current strength gradually up to 
10 mil., or suiificient to produce the desired effect. 
' When the electrode has entered the uterus to the fundus, 
increase the current to 20 mil. In five minutes reduce the 
current slowly to zero, withdraw the electrode and close the 
sitting. In subsequent applications the current strength may 
be gradually increased from 20 up to about 40 mil., always, 
however, keeping within the point pf intra-uterine tolerance. 
A glycerine tampon may be inserted after treatment if 
support and depletion is indicated, or if local tenderness exists 
a short stance of vaginal bipolar sedation should always 
follow. Bipolar and galvanic applications may be alternated 
three times a week between the periods if the case requires 
regular and systematic treatment. The patient is not required 
to rest in bed after treatment or make any change in her daily 
habits. Relief is usually prompt and satisfactory unless other 
complications retard results. In dilating the stenosis a gradual 



3i6 



TREATMENT OF DYSMENORRHCEA. 



increase in the size of the electrode employed will increase the 
diameter of the canal until drainage is adequate. Stenosis is 
probably not a very decided factor in the causation of dysme- 
norrhcea. 

Dysmenorrhoea with Incomplete Development of the 
XSterus.—Faradtc. — Place a felt-covered, flat electrode, 6X9, on 




Fig. 69. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

the lower abdomen and connect it with the positive pole of a 
high potential induction coil apparatus. Prepare vagina with 
antiseptic douche, sterilize and insert an intra-uterine electrode 
sound to the fundus and connect it with the negative pole. 




NEGATIVE. 

Fig. 70. Intra-uterine tips for negative pole. 

Switch into circuit four or five cells and the rapid vibrator. 
Support the electrode so that no unpleasant pressure is felt by 
the patient. The dose of current desired is that which will 
produce vigorous nutritional exercise of the muscular fibres of 
the uterus and adjacent tissues, without subsequent fatigue or 
pain, and it must be ascertained by tentative trial in each case. 

Begin with the longest high potential coil and increase the 
current strength from zero until the desired dose is reached, no 
matter what coil is finally found to be required for the proper 



TREATMENT OF DYSMENORRHCEA. 317 

effect. When the internal electrode is felt by the patient to 
grasp the tissues with a firm but comfortable contraction, pro- 
duce regular and strong momentary impulses of the current 
beyond this strength by a rapid movement of the primary 
rheostat so as to cut out sufficient resistance to carry the dose 
to extreme tolerance and immediately return the resistance 
and relax the contraction. These wave-like and strong impulses 
may be repeated fifteen or twenty times a minute. Total 
length of sitting ten minutes, repeated three times a week be- 
tween periods. The external electrode may alternately be 
placed over the lower abdomen and under the sacrum. 

The use of the slow vibrator is generally advised to produce 
muscular contraction, but the contractions of the widely dif- 
fused, painless, and efficient method described above are some- 
times superior to other plans of treatment. With an improved 
apparatus in which all gradations of E. M. F. and different 
coils are at command through- the simple and instantaneous 
movement of a switch, the regulation of dose is independent of 
former directions as to the choice of fine or coarse coils and 
the perplexities of making a selection are cleared away. The 
author's rheostat in the secondary circuit not only controls the 
regulation of the current to suit each case, but obviates the 
shocks which were attendant upon switch changes in older 
types of apparatus, in which the E. M. F. was controlled only 
in the primary circuit. 

In cases with scant menstruation the intra-uterine bipolar 
electrode may be preferably employed. 





Fig. 71. Intra-uterine bipolar electrode. (Faradic.) 

Percutaneous Galvanism in Dysmenorrhcea.— The relief 
afforded by the soothing galvanic current passed through 
the pelvic tissues at the time of pain is very different from the 



3i8 TREATMENT OF DVSMENORRHCEA. 

effects of narcotics, anodynes, and the much advertised utero- 
sedative drug preparations. Galvanic sedation is also tonic and 
nutritional and imparts a general sense of well-being to the 
patient. I have seen it remove the pain in very severe 
paroxysms when anodynes merely stupefied the patient's sense 
of pain for a short time with depressing and disagreeable effects. 

If the dysmenorrhoea is complicated by displacement and by 
chronic lesions, the relief afforded by percutaneous galvanism 
will be only temporary, although satisfactory in kind. Curative 
treatment with electricity during the inter-menstrual periods 
will be required to lessen the need of administrations for the 
relief of pain, and as few patients are so situated that repeti- 
tions of the percutaneous application would be convenient (if 
severe suffering during a period rendered them necessary), the 
resort to drug palliatives obtains preference in practice. 

The influence of the continuous galvanic current upon the 
nutrition of tissues and upon functional processes is illustrated 
by many cases treated successfully with percutaneous applica- 
tions alone. Williams cites the following : 

Miss C , aged 26. Menses regular and normal until the 

age of 21. At that time during a menstrual period she was 
out boating and capsized. The cold bath and shock stopped 
the flow. The menses became afterwards irregular, intensely 
painful and accompanied by mental disturbances. She was 
seen by me for the first time one year ago. Ordinary treat- 
ment had resulted in absolutely no benefit. Examination re- 
vealed a highly inflamed cervix, very sensitive and bleeding at 
the slightest touch. Vagina also very sensitive. For two 
hours before flow appeared and until two to four hours there- 
after she suffered intense uterine and head pains with almost 
mania. Opiates had been administered for two years. 

Requesting to be called at the time of next period I found 
her suffering as usual, and applied a negative electrode over the 
second lumbar vertebrae with a positive electrode over the an- 
terior region of the uterus. A mild constant galvanic current 
was passed through the tissues for twenty minutes. At the end 
of that time she was asleep and slept for six hours, awaking with 
comparatively little pain. After the cessation of the flow I 
repeated the same treatment twice a week until the next period, 
which came on in four weeks. At this period the pain was 



TREATMENT OF DYSMENORRHCEA. 



319 



not so great, but I proceeded as upon the former occasion. 
With this treatment alone for three months the patient was 




Fig. 72. Felt or sponge-covered flat electrodes, assorted sizes. 



discharged cured. She was seen recently and reports that she 
has had no recurrence of menstrual pain. 

Dysmenorrhoea Due to Inflamed Ovaries.— This condition 
may be recognized by the exquisite tenderness to pressure 
and sensations of nausea accompanying the vaginal examina- 
tion. The resources of vaginal bipolar faradic sedation will 
commence the improvement of these cases which will go on to 
complete relief when supplemented by the positive galvanic 
current applied against the ovary. Full directions for the 
treatment of these cases will be found under Ovaritis. Percu- 
taneous galvanism is also often useful as illustrated in the fol- 
lowing case : 



Miss M , age twenty-two, referred by Dr. C. with the fol- 
lowing letter: " Miss M. has been a victim of most persistent 
headache for two years — recently associated with backache 
and dysmenorrhea. After exhausting every theory and method 
of treatment which has seemed applicable I am driven by ex- 
clusion to ask you to look for and treat any existing pelvic 
trouble." 

Examination revealed right ovary tender, swollen, and pro- 
lapsed ; uterus in normal position. She received fourteen (14) 
applications of galvanism Avith the negative woven wire elec- 
trode, 2J^X3 inches, over the ovarian region, and the positive 



320 TREATMENT OF DYSMENORRHCEA. 

woven wire electrode, 3X5 inches, in the sacral region ; current 
strength, 20-30 milliamp^res. Discharged cured. {Brown) 

Dysmenorrhcea Due to Inflammation of the Tubes. — The 

pain caused by contraction of the orifices of the tubes or the 
constriction of pelvic exudations is gradually relieved during 
the treatment described for the inflammatory process. " Many 
of these cases," says Smith, " have been urged to have lapa- 
rotomy performed, by others and some even by myself, and 
yet after from five to fifteen treatments the majority of them 
have remained free from symptoms for three or four years. 
In one of them with the uterus firmly bound down in retro- 
version, although the exudation was nearly all absorbed, I was 
never able to replace the uterus, but the patient regained her 
health and strength and only requires to make two visits to my 
office about three times a year to keep her pelvis in fair condi- 
tion. I have offered to perform hysterorrhaphy, but she de- 
clines as long as she can keep so well with so little trouble." 

A Discussion on Dysmenorrhcea. — To illustrate the un- 
fortunate confusion which exists in the general relation of the 
healing art to dysmenorrhcea I will quote briefly from the 
transactions of a gynecological society in one of our largest 
cities. 

In a paper upon the treatment of dysmenorrhcea with the 
galvanic current published in J anuary, 1 897, one of the members 
reported : 

" Seventy-five per cent, of my cases have been relieved from 
the first, and twenty-five per cent, have required no treatment 
after eight or ten weeks. One or two of the greatest sufferers 
that have come under my care have been quite free from pain 
at the menstrual period for nearly three years; others returned 
for treatment before the expected period once a month, while 
some are seen only once in five or six months and report much 
relief. It has been my custom to apply treatment once a week 
for a month, and then a few days before menstruation for a 
few times, after which the frequency is in accordance with the 
indications. I have found five or six minutes long enough for 
each application," 



TREATMENT OF DYSMENORRHCEA. 32 1 

The method employed by the above physician was the 
simple, ordinary intra-uterine application of an alterative, nu- 
tritional, galvanic current of from 1 5 tb 20 milliamperes. If the 
operator, who seems to have considered that this represented 
about all that could be done with electricity, had employed 
the other familiar methods in addition, he would have secured 
better results in some cases, and in many other cases would 
have procured his best results more quickly. In still other 
cases in which intra-uterine negative galvanism is not indicated at 
all his patients could have been benefited by some of the other 
manifold means within the scope of electro-therapeutics. The 
remedial action of electricity in dysmenorrhcea (or in any other 
pelvic disease) is not exhausted by any single method, for there 
are three great currents, each capable of great diversity of 
action through, diversity in apparatus and technique. 

The discussion which followed the paper was participated in 
by nine leading practitioners. The report of the discussion 
really reads like a travesty upon scientific medical progress, and 
betrayed throughout an ignorance of the very A B C of the 
thoroughly demonstrated teachings of electro-physiology and 
clinical experience. Discussions of this character are reported 
in medical journals and read by physicians who are apt to 
assume that the floundering of the speakers in the depths of 
their own ignorance, and their inquiries upon points which 
belong to the primer stage of study, as if they were still 
perplexing the most scientific investigators, is proof that the 
whole profession is equally uninformed. Such an impression 
is difficult to counteract, but probably every published word 
would be sponged from the records by the speakers themselves 
if they would spend two hours' time with a reliable treatise on 
the subject. 

At a later meeting of the same society (reported in March, 
1897), the chief speaker referred dysmenorrhcea to four 
causes : 

I. Structural lesions of the uterus itself, malformations, or 

an undue density of the structure of the uterus which inter- 
21 



322 TREATMENT OF DYSMENORRHCEA. 

feres with the hyperaemia that occurs during the menstrual 
wave. 

2. Inflammatory affections of the uterus. 

3. Ovarian disease. 

4. Neurosis. 

He considered that about one-fourth of all cases of dysme- 
norrhoea were of neurotic origin. The discussion developed 
most prominently the confusion which exists in regard to 
methods of treatment. Local applications, sedatives, etc., 
were threshed over like old straw in the usual manner, and the 
reason for the popularity of operations becomes clearly mani- 
fest when we carefully review some of the measures which 
precede them. One of the most competent gynecologists 
belonging to the society deliberately stated : 

" My experience in the treatment of dysmenorrhcea has 
simply been one to disgust me with the whole subject. I have 
never been successful with any kind of treatment with dysme- 
norrhcea pure and simple. If we call painful menstruation 
from mechanical obstruction dysmenorrhcea, then something 
is to be done ; the obstruction can be removed, the canal 
straightened out, and we get the result we might expect. But 
there are a number of patients who suffer with dysmenorrhcea 
when you can find no lesion of the uterus or its surrounding 
organs of any kind, and those cases I have failed to relieve in 
any way whatever. I have in my mind now a patient who has 
just left the hospital who has been operated on several times 
and always ' cured,' but the trouble with her cure is that she 
don't stay cured. She comes back, and I generally find her 
there at the beginning of my term of service, going through 
the curing process, and she meets me with a malicious grin 
as much as to say ' Now, you see I can be cured,' and she 
generally turns up in the next six months to meet me with 
the same experience exactly." 

This speaker did not employ medical electricity. 

In the proceedings of the same gynecological society re- 
ported in May, 1897, the paper of the evening referred to cases 
of dysmenorrhcea " in which the suffering begins at or soon 
after puberty, and continues, unless interrupted by treatment 



TREATMENT OF DYSMENORRHCEA. 323 

or pregnancy throughout the whole or a greater part of the 
climacteric period." 

The method of treatment was the injection of ten minims 
of a three-per-cent. mixture of Churchill's tincture of iodine 
and water into the uterine cavity every four or five days dur- 
ing the inter-menstrual period. 

I shall have failedin the purpose of this book if I do not make 
plain to physicians more hopeful m.ethods of treating the condi- 
tions which produce menstrual pain. 

Fully two-thirds of what are now considered operative cases 
may also be included in the statement that the practical and 
simple methods described here with sufificient detail to be 
easily employed by any one who will procure the proper ap- 
paratus and study the rudiments of the subject will accom- 
plish more for the relief of suffering and the restoration of the 
patient to comfortable health than other local measures em- 
ployed in the routine manner. 

The indications for the form of current, the polarity, the 
choice of electrodes and regulation of dose are as simple as any- 
thing in electro-therapeutics. The physician who commands 
the resources of electrical currents and will support them by 
common sense, and by hygienic, medicinal and nutritional 
measures when they are needed, will find himself baffled by 
very few cases of dysmenorrhoea. 

Practically all cases dependent upon neurotic causes" can be 
cured by the aid of the static machine and bipolar faradization. 

The class of cases dependent on hypersesthesia of the 
uterine membrane will be relieved by the conjoint action of bi- 
polar sedation, and the intra-uterine application of positive 
galvanism. 

Cases dependent upon some grade of endometritis will best 
be treated by intra-uterine galvanic applications with either 
the positive or negative pole according to the state of the 
tissues. The indications for the choice of poles will be found 
definitely stated in the chapter on Galvanic Physiology. In 
these cases there is almost invariably a need for bipolar faradi- 



324 TREATMENT OF DYSMENORRHCEA. 

zation, and in many cases the static machine can do much to 
promote the general health. 

When " an undue density of the structure of the uterus inter- 
feres with the hypersemia that occurs during the menstrual 
wave," the physician who will study the electrolytic action of 
the negative galvanic current will speedily satisfy himself that 
it is the best resource in his armamentarium. 

When displacements and structural changes of the uterus are 
present, and, in fact, in all conditions short of active suppur- 
ation, cystic degeneration and malignant disease, some useful 
service will be performed by a skilful combination of one or 
more of electro-medical methods. 

And last, if I am asked about my own humble experience, I 
would say that I can recall case after case in which operative 
treatment has been urged by the opponents of electricity in 
disorders of menstruation in which perfect cures have been ob- 
tained by the aid of this harmless remedy. Cases of amenor- 
rhoea in stout women who have been made to menstruate ; in 
sterile women who have been made able to conceive ; of women 
who have suffered untold agony at their menstrual period and 
for the most of the time between it and the next ; who, have 
been made to see the flow come on absolutely without the 
slightest pain — so much so indeed that instead of having a 
week or two of preliminary suffering it has come on without 
their knowing it and without even being prepared for it. 
. (Smith.) 



CHAPTER XIX. 

TREATMENT OF UTERINE ENLARGEMENTS. 

Venous engorgement of the uterus and pelvic tissues. Congestion, catarrhal in- 
flammation, and enlargement of the uterus caused by mechanical displace- 
ment. Subinvolution. Electrical methods. Chronic sub-involution. Treat- 
ment of complications. A case of chi-onic metritis. 

Venous Engorgement of the Uterus and Pelvic Tissues. — 

Prescribe remedies to regulate the action of the Hver and 
bowels and employ vaginal bipolar faradization. Regulate the 
current strength for stimulating and tonic rather than for 
sedative effects. Repeat daily at first and later three or four 
times a week until circulation and nutrition become normal. 
Full directions for the bipolar method are described under 
bipolar faradization. 




Fig. 73. Bipolar vaginal electrode. 

Congestion, Catharrhal Inflammation, and Enlargement 
of the Uterus caused by Mechanical Displacement. — Initiate 
treatment with vaginal bipolar sedation for twenty minutes, 
repeated three times a week between menstrual periods until 
local tenderness is relieved and neurasthenic symptoms abate. 
If circumstances permit daily sittings they are advisable during 
the first two weeks. 

In recent and uncomplicated cases the ultimate benefit de- 
rived from persistent bipolar faradization passing from sedative 

325 



326 



TREATMENT OF UTERINE ENLARGEMENTS. 





Fig. 74. Intra-uterine bipolar electrode. (Faradic.) 

into tonic and finally into muscle contracting actions may 
render other treatment unnecessary. In older cases we must 
employ additional measures. 

Place a felt-covered, flat electrode, 7X10, on the abdomen 




Fig. 75. Fine felt or sponge-covered electrode — assorted sizes with soft rubber 
insulating backs. 

or under the sacrum — whichever situation brings it nearest to 
the fundus of the uterus. Expose the parts as usual by the 
aid of a speculum and swab out the vagina with a pledget of 
absorbent cotton dipped in a carbolic or creolin solution. Insert 
carefully into the uterine cavity the platinum or pure tin elec- 
trode-sound, and in all hemorrhagic conditions, or if any form 



Fig. 76. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 

of discharge, whether menstrual or leucorrhceal, is abundant 
connect it with the positive galvanic pole. Make external 
electrode negative. 

Gradually increase the constant galvanic current through the 
rheostat from zero up to 20 or 30 mil. Maintain the maximum 



TREATMENT OF UTERINE ENLARGEMENTS. 



32; 



current for about five minutes and then slowly reduce to zero. 
Entire stance, ten minutes. 

Repeat the galvanic application two or three times weekly 
for several months, or until improvement is sufficient. Keep 
the current within comfortable tolerance at all times. In the 
early stages of .treatment the dose may need to be kept below 
30 mil., and will rarely advance beyond 50 mil., at any time, 
even after full tolerance is established. 

When improvement is ready for muscle-contracting measures 
to supplement the constant galvanic current, switch the auto- 
matic rheotome into circuit and again increase the current 
strength sufficiently to produce vigorous contractions at the 
rate of about 70 per minute. About three minutes may be 
devoted to the interrupted cnrrent at the close of each constant 
current application. In alternation with this method it is well 
to continue the vaginal bipolar faradization. 

If tenderness in created at any period in the course of treat- 
ment return to bipolar sedation exclusively until it is removed. 

Omit galvanic treatment two days before expected men- 
struation, and wait a couple of days after the flow ceases be- 
fore resuming, and it is prudent to limit the first treatment 
after menstruation to vaginal bipolar sedation only. 

If the uterus has become fixed by fibrous adhesions resulting 
from old peri-uterine inflammation, precede the intra-uterine 
galvanic treatment by vaginal galvanic applications. These 




Fig. 77. Electrode for vaginal hydro-electric applications. 



328 TREATMENT OF UTERINE ENLARGEMENTS. 



Fig. 78. Carbon ball electrode. 

may be begun by a short course of negative hydro-electric 
douches (which see), or the carbon ball electrode wrapped with 
absorbent cotton may be employed as described in the section 
devoted to these conditions. 

If the catarrhal affection has extended upwards into the 
tubes defer all intra-uterine methods until bipolar sedation and 
hydro-electric douches or vaginal galvanic treatments improve 
the condition and prepare toleration for other measures. Pus, 
if present, can be evacuated first and subsequent applications 
made as indicated. 

If the case is mainly one of uncomplicated catarrhal hyper- 
trophy of the uterus without free discharges they should be 
established by negative intra-uterine electrolysis as soon as 
it can be employed without irritability. Intolerance to the- 
negative current applied with reasonable care, directed to alter- 
ative and free drainage effects, would indicate inflammation of 
the adnexa or suppuration in the tubes. The significance of 
warnings in this respect will be found among the different 
contra-indications and remarks on diagnosis. 

In catarrhal hyperplasias of the uterus electricity has a four- 
fold value far exceeding the usefulness of any other therapeutic 
agent, for it directly combats the catarrhal process, stimulates 
absorption and nutrition, and by contracting the tnuscular fibres 
lessens the uterine bulk. 

Among the therapeutic measures of gynecology electrical 
currents take easily the foremost rank in both general and 
special usefulness. Many of the topical applications and pro- 
cedures of routine medical treatment of the pelvic affections 
of women appear altogether puerile in contrast with the 
resourceful and effective measures of electro-gynecology. It 
must also be said that much of popular surgery would be with- 
out excuse if both surgeons and general practitioners gave 



TREATMENT OF UTERINE ENLARGEMENTS. 329 

their patients the prior benefit of medical electricity. Be- 
tween the limitations of strictly medical treatment and unavoid- 
able surgery of the pelvic viscera the demonstrated services of 
electric currents are of such scope and value as to render them 
indispensable. They are employed with facility and produce 
curative results in some conditions which are exceedingly 
difficult to reach by other means. They combine local and 
constitutional effects in the happiest manner, and they win the 
confidence, appreciation and gratitude of patients. 

Subinvolution. — In recent cases the faradic current is in- 
dicated and may be efficiently employed by any one of five 
different methods, according to the judgment of the expert 
physician: i. Both electrodes situated externally. 2. Mono- 
polar vaginal method. 3. Bipolar vaginal method. 4. Bipolar 
intra-uterine method. 5. Mono-polar intra-uterine method. . 

To these variations in the situation of electrodes may be 
added variations in the use of rapid or slow interruptions. 

The bipolar intra-uterine method cannot always be con- 
sidered safe as the electrode is difficult to sterilize. The exter- 
nal method with one electrode under the sacrum and the other 
promenaded over the fundus of the uterus is of limited service 
in the recent condition just after delivery. Practically almost 
every case may best be begun with vaginal bipolar faradiza- 
tion. 

If the condition is a passive hypersemia and uncontracted 
state of the muscular fibres requiring simply a stimulus to cir- 
culation, nutrition and contraction for its removal, the action 
of induction coil currents will suffice. 

When more than six months has elapsed before commencing 
treatment and chronic changes have taken place in the struc- 
tures the electrolytic action of the galvanic current will also be 
essential to secure results. 

If the uterus is large and hard and the chronic condition is 
complicated the measures required during the course of treat- 
ment may call for the entire resources of the electro-therapeutist. 
In the following section the details of the management of a 



330 TREATMENT OF UTERINE ENLARGEMENTS. 

case which demands more than bipolar faradization will be 
considered more fully. 

Chronic Subinvolution, with or without associated flexion, 
version or prolapsus of any degree. 

In cases in which structural changes have become more or 
less established through the lapse of time commence the treat- 
ment always with bipolar faradization. 

First improve the general pelvic condition, relieve tender- 
ness and pain if they exist, and reduce congestion and promote 




Fig. 79. Bipolar vaginal electrode. 

a re-absorption of the infiltrated fluids by preliminary vaginal 
bipolar sedation. Later pass to short coil stimulation. 

After a very few sittings a more tonic action of the current 
will be tolerated, and in infinitely less time than any other 
method would produce such a result we may employ cur- 
rents which will stimulate the contraction of muscular fibres. 
Repeat sittings three times a week and continue the bipolar 
method throughout the entire management of the case. 

As soon as all evidence of tenderness has disappeared the 
tissues may be considered prepared for direct electrolytic action 
of the galvanic current which is indispensable for results in 
chronic cases. It must be employed hand in hand with the 
bipolar coil current and the actions of both supplement each 
other. One lightens the weight of the uterus, the other tones up 
its supports. 

At the next sitting after sedation has been completed, 
(whether this has required a week or more depends upon the 
complications of the particular case) place the usual felt-covered, 
flat electrode, 7X 10, upon the abdomen or under the lumbo- 
sacral spine. These situations should be alternated at different 



TREATMENT OF UTERINE ENLARGEMENTS. 33 1 




Fig. 80. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

sittings during the course of treatment so that the path of the 
current will not be limited to either one side or the other. 
This is always the rule in the treatment of chronic uterine 
affections. The routine of always placing the external electrode 
upon the abdomen is a great mistake. 

Select the most suitable intra-uterine electrode-sound ad- 



NEGATIVE. 

Fig. 81. Intra-uterine tips for negative pole. 

apted to the canal of the given case. If the condition has been 
hemorrhagic or irritable, and the uterus is soft and spongy, the 
indications for the positive pole are absolute, and therefore the 
electrode must be of platinum or pure tin. In all cases the 
first applications within the uterus should be made with the 
positive current without regard to the indications for later 
treatment. This rule is dictated by prudence and experience. 
After cleansing the parts and sterilizing the surface of the 
electrode in the usual manner insert the electrode to the fundus 
of the uterus and connect it to the positive pole. Support it 
gently in position without pressure, and gradually increase the 
constant galvanic current through the rheostat from zero up to 



332 TREATMENT OF UTERINE ENLARGEMENTS. 

20 mil. In five minutes increase it to 30 mil., which is usu- 
ally sufficient for the first sitting, and if comfortably tolerated 
affords satisfactory evidence of the state of the tissues. After 
holding the maximum dose for three minutes reduce the current 
gradually to zero. Total length of galvanic application may 
vary from ten to fifteen minutes. Repeat two or three times 
a week between menstrual periods. 

As tolerance becomes established at successive sittings the 
current should be increased in proportion until 60 or 70 or 
even 100 mil. is reached. 

Immediately after withdrawing the galvanic electrodes insert 
the vaginal bipolar electrode and for about five minutes apply 
as strong a current as the tissues will accept, to contract down 
the uterus and drain out the canal. 

When, after from six to a dozen positive galvanic applications, 
the hemorrhagic and spongy condition has been largely over- 
come, the indications for the galvanic current cease to be dis- 
tinctly positive and may thereafter call for the negative current, 
either partly or wholly. 

Cases are rare, however, in which either polarity is exclusively 
employed throughout any long course of treatment. They 
must usually alternate to conform to the varying conditions 
which confront the operator throughout the fluctuations of 
pelvic disease. The indications for the negative current are 
explicitly laid down in the chapter on Electro-physiology, 
• and there is no uncertainty about when to employ negative 
electrolysis. 

The electrodes may be precisely the same as for the positive 
application. The technique is the same, and the only differ- 
ence in the adjustment of the apparatus consists in reversing 
the polarity. 

In case any aggravation in the patient's condition occurs 
during the course of negative treatment return to the positive 
application until irritation subsides. Aggravations may occur 
in the uterine ill-health of women from many causes, and must 
be met as they occur. In speaking of them in these pages I 



TREATMENT OF UTERINE ENLARGEMENTS. 333 

do not refer to such aggravation as might possibly be caused 
by a contra-indicated application, for the experienced operator 
does not hurt his patients much oftener than does the careful 
prescriber of any other remedy. 

If the uterus, however, is found at the beginning to be dense 
and hard, and menstruation has been normal or scanty in 
amount, the indication for employing negative electrolysis 
exists at the outset and the delay in employing it need be no 
greater than the two or three sittings usually allowed in prac- 
tice to compose the patient and determine tolerance. 

When softening and electrolytic reduction of the hypertro- 
phied organ is progressing properly, it is well to end each gal- 
vanic siance, after reducing the constant current to zero; by 
switching the interrupter into circuit and again increasing the 
current strength until agreeable vigorous contractions are 
maintained for two or three minutes. Adjust the rate of tho 
"rheotome to about 70 interruptions per minute. 

Dust the site of the external electrode with toilet powder in 
all cases when it is convenient to do so, as this at once removes 
the slight itching sensation which some skins feel. 

During some stages of the case the greater part of each sit- 
ting will require the, bipolar method, and in other cases the 
chief part of the work may be done by the galvanic current. 
A little experience teaches the operator the exact adaptation 
of the technique to each case. 

A reasonable time of treatment by these combined methods 
— varying from a dozen or twenty applications in recent and 
mild cases, to several months' attendance in chronic and severer 
cases — will accomplish more satisfactory results than can be 
expected from other measures. Electricity has no peer in the 
treatment of subinvolution, and any other depleting and sup- 
porting methods that the science of medicine or surgery con- 
tains can be employed intelligently at the same time without 
preventing the physician from giving his patients the benefit of 
the remedy in chief. 

Complications.—" Shreds of retained decidua, a morbid 



334 



TREATMENT OF UTERINE ENLARGEMENTS. 



condition of the endometrium, a laceration or other traumatic 
accidents are often the determining cause of a septic endome- 
tritis to which the subinvolution is due." 

For a septic condition of the uterus the positive galvanic 
current is indicated, and if there are but slight portions of re- 
tained membrane it is by no means necessary to curette. The 
drainage established by the galvanic application will usually 
suffice to carry away the shreds which the action of the current 
also detaches. If, however, in other cases the curette is neces- 
sary to remove larger and more dangerous fragments, it should 
be employed before the galvanic treatment is begun. The 
case will then proceed satisfactorily under the positive current. 




Fig. 82. Five electrodes : insulated with soft rubber tubing to expose any de- 
sired surface. 



Chronic Subinvolution with Neurasthenia. — Mrs. 



-, aged 



27, well nourished but emotional and neurasthenic. ' Instru- 
mental delivery eight years previous was followed by sepsis. 

Miscarriage two years later was followed by chronic invalid- 
ism, — cincture-like pains in loins, back and limbs, continuous 
slight menorrhagia and severe dysmenorrhcea, followed by 
leucorrhcea, uterus hard and brawny, corpus enlarged and ten- 
der with Os exuding copious uterine mucous. Depth of cavity, 
three inches. Laceration of cervix had been repaired without 
relief of symptoms. General electricity, massage and the " rest 
cure" had failed. 

A negative intra-uterine application of 50 mil. for three 
minutes was followed by twenty hours rest in bed. Three 
hours after the application the cincture pain disappeared for 



TREATMENT OF UTERINE ENLARGEMENTS. 33S 

the first time in eight years and has not returned since. Three 
subsequent applications of forty, thirty-five and thirty-five mil. 
of the negative galvanic current were made at intervals of four 
to six days, alternated with faradic applications. The patient 
was discharged with a 2}^ inch cavity and in perfect health, 
which a recent letter reports as permanent. (Massey^ 



CHAPTER XX. 
TREATMENT OF UTERINE DISPLACEMENTS. 

Recent cases. Displacements with relaxed and congested conditions of the uterus 
and vaginal walls. Treatment of chronic anteversions and anteflexions. 
Treatment of chronic retroversions and retroflex:ions. Treatment of uterine 
conditions due to relaxation of muscular fibre and altered nutrition. Uterine 
prolapsus. A case of procidentia. A surgical discussion upon the treatment 
of retro-displacements of the uterus. 

Uterine Displacements. — In simple and recent cases with- 
out adhesions or structural changes the correction of the 
dislocation is often admirably established by percutaneous 
galvanism. 

Remember that the positive polar action pushes fluids away 
from it towards the negative pole, hence, to lighten the heavy 
side of the fundus, apply the positive electrode under the 
sacrum and the negative on the abdomen, if there is a back- 
ward displacement, and reverse this polarity if the displace- 
ment is forward. 



Fig. 83. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

Increase the constant galvanic current from zero up to 30 
mil., and after fifteen minutes reduce gradually to zero. At 
once switch the automatic rheotome into circuit and again 

336 



TREATMENT OF U.TERINE DISPLACEMENTS. ' 337 

increase the current from zero until comfortably strong pulsa- 
tions are felt through the pelvis. Adjust the rate of interrup- 
tion to about 100 periods per minute. 

After about three minutes of the interrupted application 
reduce the current to zero and remove the electrodes. Dry 
and dust the skin with toilet powder. Repeat three times, a 
week, or oftener if convenient. Improvement will be rapid in 
.uncomplicated cases. 

In addition to immediate replacement in these recent cases, 
and providing support in the normal position until the local 
disturbance of the tissues is repaired, we have, in the well- 
known electrolytic and sedative-tonic effects of electricity, an 
auxiliary aid to nature and the tampon or pessaiy which prac- 
tically fulfils the indications for treatment. 

Recent Uterine Displacements, with Relaxed and Con- 
gested Condition of the Uterus and Vaginal Walls. — The 
first indication after replacement is to tone up and restore the 
muscular supports of the uterus and at the same time allay 
any pelvic congestion or irritation resulting from the accident. 

The action of the percutaneous method above described is 




Fig. 84. Bipolar electrode. 

sometimes sufficient, but to procure these effects we also pos- 
sess the more distinctly localized method of vaginal bipolar 
faradization. Repeat this daily for about fifteen minutes, 
gradually passing from the 1,500 yard No. 36 coil to the No. 
32 coil as improvement advances and more tonic effects are 
required. When sedation is complete after the first few sit- 
■ tings and simple stimulation of muscular fibres to hold the 
uterus in place alone remains indicated, the sitting may be 
shortened to ten minutes and the stimulating method of man- 
aging the current employed. For full directions see Bipolar 

Faradization in previous chapter. 
22 



338 TREATMENT OF UTERINE DISPLACEMENTS. 

The number of applications by these methods required to 
repair the slight damage of recent accidents will be very few, 
and in proportion as the damage is more severe or has been 
longer neglected, the operator may continue the treatment, 
according to the progress of the individual case. The usual 
glycerine or astringent tampon may be inserted after the 
withdrawal of the electrode. 

If the lining membrane of the uterus is discovered to be 
congested or inflamed, bipolar sedation should be followed 
shortly by the sedative-tonic and curative action of the positive 
intra-uterine galvanic current with mild dosage. This appli- 
cation should be reserved, however, for cases in which the in- 
flammatory state is established and not amenable to relief by 
vaginal bipolar sedation. When the galvanic current is em- 
ployed in these cases it should precede the bipolar application 
at the same sitting. 

Place a felt or sponge covered, flat electrode, about 6X9, on 




Fig. 85. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

the lower abdomen or under the lumbo-sacral region. In most 
cases in gynecological practice the latter is the most conven- 
ient region, especially when small currents are employed, as the 
electrode may often be slipped between the clothing and the 
back with much less trouble than is required to open the gar- 
ments and apply the electrode in front. 

Connect the external electrode with the negative pole of the 
galvanic battery and insert the positive platinum electrode- 



TREATMENT OF UTERINE DISPLACEMENTS. 



339 



Fig. 86. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 



sound to the fundus of the uterus. Very cautiously increase 
the constant current through the rheostat from zero to about 
IS mil. Do not cause any pain by the application. Expect 
a rapid and continuous increase of tolerance during successive 
treatments, if the application is properly indicated and prop- 
erly performed. In the absence of sufficient experience to 
guide his judgment without clinical tests, the operator may 
consider that an aggravation, if any is caused, is notice to 
desist. Follow the galvanic administration with the usual bi- 
polar treatment. 

Rapid restoration of the normal state of the tissues will 
ordinarily follow these methods of treatment in recent trau- 
matism. 

A useful' inter-current method is the hydro-electric douche. 
Moisten a felt-covered, flat electrode, 7 X 10, in a one per cent, 
hot-water bicarbonate of soda solution, and apply it upon the 
abdomen, with the patient in the dorsal position on the oper- 
ating table. Connect this with the positive galvanic pole. 




Fig. 87. Electrode for vaginal hydro-electric applications. 



340 TREATMENT OF UTERINE DISPLACEMENTS. 

Prepare about three quarts of any preferred alkaline and anti- 
septic solution in the irrigating jar, placed at a sufficient height 
to administer an ordinary vaginal douche. Attach the end of 
the rubber tube to the vaginal electrode and connect the elec- 
trode to the negative galvanic pole. Have the water hot. 
When the electrode is inserted turn the stop-cock of the rubber 
tube and allow a continuous flow of the solution. Increase 
the constant' galvanic current from zero up to about 40 mil. 
and maintain the current until the irrigator is empty, or for 
fifteen or more minutes. 

Prescribe other measures indicated in each individual case, 
repeat some form of the electrical application daily for a few 
days and three times a week until recovered. 

Chronic Anteversions and Anteflexions. — The treatment 
of these differs in degree according to the conditions present 
at the time the patient is first seen. A synopsis of the varia- 
tions of methods usually required will be given under this one 
heading for the purpose of descriptive simplicity, but the 
judgment of the physician must regulate the applications to 
suit each case. 

It is necessary to procure sedation of local tenderness and 
congestion to dilate and render the canal patulous for drain- 
age, to soften and absorb exudative deposits and bands of 
adhesion which hold the uterus fixed, to soften and relax an 
indurated and anchored uterus, to cure the chronic inflamma- 
tion of its lining membrane, if it be so inflamed, and. to restore 
mobility and tone and strength to the uterus and its muscular 
supports. These steps, whether simple or complex and tedious, 
according to the severity of the case, come within the scope 
of electrical procedures, and the full plan of treatment will 
spring at once'to the mind of the trained student of electro- 
physiology. 

Three means of localizing polar action constitute the major 
measures to be employed, to wit : bipolar faradization, positive 
or negative vaginal electrolysis, or positive or negative' intra- 
uterine electrolysis. 



TREATMENT OF UTERINE DISPLACEMENTS. 34I 

Not all of these will be needed in every case, and if the mal- 
position is not complicated by inflammation or the results of 
inflammation, the bipolar and negative galvanic current will do 
the bulk of the work. As the greater includes the less I will 
describe the electrical treatment of a complicated case. 

Begin with vaginal bipolar faradization. By clinical test 
determine the sensitiveness of the general pelvic tissues and 




Fig. 88. Bipolar vaginal electrode. 

gradually arrive at the greatest current strength that can be 
well tolerated. If this proves to be only the longer No. 36 
coil with an E. M. F. of four cells the faradization must be 
regulated for sedative effects at first, and gradually increased to 
tonic and stimulating massage effects when improvement sufifl- 
ciently advances. 

Bipolar rapidly interrupted induction coil current applica- 
tions constitute the foundation of the plan of treatment, for 
the following important reasons : 

1. For their primary sedative effects. 

2. For their inter-current usefulness in allaying erratic or 
neurotic symptoms that may exist or arise. 

3. For their corrective influence upon possible temporary 
aggravation by intra-uterine electrolysis, when this occurs. 

4. For their power, in non-inflammatory states and vigorous 
dosage, to bt:eak up and disperse exudation material and adhe- 
sive bands. 

5. For their tonic action upon the supporting structures of 
the uterus and the uterus itself. 

6. For their tonic and nutritional effects upon the general 
system of the patient. 

The first attention to the uterine cavity (in all cases which 



342 TREATMENT OF UTERINE DISPLACEMENTS. 

require it), consists in making the canal patulous if drainage is 
obstructed, and allaying irritability before active treatment of 
metritis or endometritis is begun. 

The method of dilating a stenosis of the Os or the indurated 
angle of an old flexion by negative galvanic electrolysis is 
described in these chapters under their separate headings. 
Employ negative dilatation when it is needed, and repeat it 
until the canal affords satisfactory drainage as well as the free 
admission of an electrode-sound. 

When the canal will at first admit an electrode, in- simpler 
versions, or when entrance has been effected in the more 
extreme flexions, the first intra-uterine application of galvanism 
should always be made with the positive pole. If there is 
hyperesthesia and tenderness to pressure associated with the 
chronic metritis or endometritis, which exist in severer cases, 
the indication for mild positive galvanism is absolute. 

If there is no observable indication for positive at the time 
of treatment it is a wise precaution (and my invariable rule) to 
test the uterine tolerance with this polarity first in all cases. 
Profuse menstruation in the history of these cases is also a 
direct indication for the continued use of the positive current 
until this sympton is abated. 

With the patient in the usual dorsal position on the oper- 
ating table place a large felt-covered, flat electrode, /X lo, 




Fig. 89. Fine felt or sponge covered electrode — assorted . sizes with soft rubber 

insulating baclc», 



TREATMENT OF UTERINE DISPLACEMENTS. 343 

upon the lower abdomen and connect No. 21 with the nega- 
tive pole of the galvanic battery. With the usual cleanliness 
and care essential in all electro-pelvic work insert the intra- 
uterine positive platinum electrode into the cavity of the uterus 



Fig. 90. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 

SO that metallic contact will be made with its entire lining. 
Gradually increase the constant galvanic current through the 
rheostat from zero up to about 20 mil., and maintain this 
dosage for five or eight minutes. 

Follow this at once by ten minutes of vaginal faradization 
regulated in dosage to the point which experience rapidly 
teaches the operator is correct. At the close of the sitting 
insert a glycerine tampon, unless it is not considered necessary. 

After each treatment the patient should experience a sense 
of well-being and a decided increase of comfort and benefit. 
Increase the galvanic amperage with each succeeding stance 
as fast as tolerance becomes established until finally 50 mil., 
and possibly 70 or 80 mil., is reached during the last half of 
each galvanic application. The indications for the higher 
intensities are clearly set forth in the chapter upon Physio- 
logical Actions. 

In the early stages of treatment one other method of appli- 
cation may be useful, either as accessory treatment of the 
endometritis, or before it can be begun, or to cause the absorp- 
tion of exudates or the removal of tenderness. This ispositive 
vaginal galvanism. , 

Apply the negative felt-covered, flat electrode, 7 X 10, upon 
the abdomen or under the sacrum, whichever situation will 
best include the diseased tissues in the path of the current. 
Wrap the carbon ball electrode with a protecting mass of 
absorbent cotton securely tied upon the staff. Moisten this 
in the usual bicarbonate of soda solution and insert it into the 



344 TREATMENT OF UTERINE DISPLACEMENTS. 

vagina (through a speculum) so that it will rest against any 
irritable mass of inflammatory deposit, if there be any such, or 
in the region of any ovarian or other congestion and tender- 
ness. The cotton covering is far less mussy than the clay 




Fig. 91. Carbon ball electrode. 

which is usually recommended, and affords perfect safety 
against a " galvanic burn " when the ball of the electrode is 
carbon instead of metal, and when only moderate currents are 
employed. It is best not to use a metallic electrode in the 
vagina with galvanic currents. 

The regulation of the dosage in this application will follow 
the usual rules, according to the size of the contact area and 
the pathological state of the tissues. Mild doses of between 
15 and 20 mil. should be employed at first, and practice quickly 
instructs the physician exactly how much amperage to use at 
any time in the treatment of any case. Duration of sitting 
about 8 minutes. 

The vaginal galvanic application may be followed by a 
glycerine tampon. It may often also be supplemented by 
the good effects of a bipolar faradic application. The latter 
does part of the work for which vaginal galvanic currents were 
formerly employed and displaces routine medical methods and 
topical applications to a very great extent. 

When treatment has sufficiently subdued the chronic inflam- 
matory condition the way has been prepared for the softening 
and relaxing, absorbing effects of negative galvanic electrolysis, 
which is the essential agent of relief. 

When the inflammatory state does not actively exist at the 
first examination of the case the negative galvanic application 
can be begun usually after the second or third stance, and the 
course of treatment proceeds without the necessity for delay 
caused by the needs for preliminary sedation. Having initiated 



TREATMENT OF UTERINE DISPLACEMENTS. 345 

treatment with the usual bipolar faradization and determined 
the intra-uterine tolerance with the prudent tentative applica- 
tion of the positive current, the operator may at the next 
sitting connect the intra-uterine electrode to the negative 
pole and employ a mild continuous current of no more than 
20 mil. 




Fig. 92. Intra-uterine electrodes, assorted sizes. 



Handle for same. 

If no aggravation occurs the amperage may be increased 
until it reaches 40 or 50 mil. in the course of a half-dozen sit- 
tings. Higher intensities and actively cauterizing effects are 
not usually desired in these cases, but when they are required 
the indications for them will be unmistakable to the physician 
who familiarizes himself with the action of different doses. 
Duration of sitting eight or ten minutes, allowing about three 
minutes for the action of the maximum current strength. 

After each galvanic application benefit will be derived from 
ten minutes' bipolar faradization followed by a suitable tampon. 

Applications may ordinarily be made three times a week 
between periods with a margin of two days before and after 
the flow. 

In outlining a plan of treatment for chronic lesions which 
may be variously complicated and present different aspects in 
different cases it obviously requires medical intelligence and 
electro-therapeutic competency to adapt the technique to the 



346 TREATMENT OF UTERINE DISPLACEMENTS. 

individual case. If initial treatment requires sedation the 
result will be hastened by daily sittings until the irritability, 
tenderness and pain are removed. The total duration of 
treatment will depend upon the perseverance and co-operation 
of the patient, and upon the skill of the operator, quite as 
much as upon the degree of uterine fixation and structural 
change. 

Symptomatic benefit of great value usually appears early in 
the case long before anatomical improvement, and this is one 
of the practical pleasing features of electric treatment. Some 
of the described applications may require to be made but once 
or twice a week, and in the later stages of progress the entire 
treatment may be limited to two sittings per week. 

Chronic Retroversions and Retroflexions.— The gross intra- 
pelvic indications for any one or all of the principal applica- 
tions of electricity, viz., vaginal or uterine faradization, pos- 
itive or negative vaginal or uterine galvanic administrations, 
are the same for the same method whatever may be the direc 
tion of the uterus. 

The softening, relaxing action of negative electrolysis does 
hot depend upon whether the indurated tissue is in the ante- 
rior or posterior part of the pelvis, nor is the an'alectrotonic, 
nutritional and cataphoric action of positive Electrolysis affected 
by topographical situation. 

In treating retroflexions the electro-therapeutist employs 
the same properties of current action as in the treatment of 
anteflexion and only modifies the technique by adapting the 
electrodes to the parts. He also supplements the uses of 
electrical currents by such other practical methods as may be 
indicated, and neglects nothing which can contribute to the 
welfare of the patient. 

Commence the pelvic treatment of every new patient with 
vaginal bipolar faradic sedation and continue it upon the well- 
known principles of following up an increasing current strength 
so long as either the patient or the local lesion requires this 



TREATMENT OF UTERINE DISPLACEMENTS. 347 

method. Gradually merge it into tonic, and finally stimulating 

dosage, in later stances during the progress of improvement. 

This part of the plan of treatment is suitable to all cases, 




NEGATIVE. 

Fig. 93. Intra-uteiine tips for negative pole. 

has no centra-indications in the lesions here referred to, and 
should be regularly and persistently employed. 

If exudative inflammatory deposits are felt about the uterus 
they should first be persistently attacked by combined galvanic 
electrolysis and osmosis, aided by the absorptive action of 
the bipolar method. Place a large felt-covered, flat electrode, 
■7X 10, upon the abdomen or sacrum, according to the situa- 
tion of the deposit, and a carbon ball electrode protected with 



Fig. 94. Positive electrode with sliding siiuttle. 

a covering of wet cotton (or of clay if a high amperage is re- 
quired) placed in the vagina against the mass. If this is soft, 
sensitive or painful, connect the vaginal electrode with the 
positive pole and increase the constant galvanic current through 
the rheostat from zero up to about 20 mil. The degree of 
tenderness will regulate the amperage, which must exactly 
reach the point of comfortable tolerance. 

As improvement advances with successive treatments the 
sensitiveness will diminish, and the dose may reach gradually 
from 30 up to 40 and finally above 50 mil., and when the indi- 
cations iox positive cease, transfer the polarity to the negative. 

When there is no longer any sensitiveness and no reaction 
is caused by the negative current, its use may be begun, — 



348 TREATMENT OF UTERINE DISPLACEMENTS. 

with a return to the positive application from time to time if 
the need for doing so occurs. 

When the mass is already painless, and dense or hard, 
negative electrolysis should be used from the start, after the 
routine preparation of the tissues and patient by bipolar fara- 
dization. The physiological action of the negative current in 
softening and liquefying the morbid mass and setting up ab- 
sorptive processes will also be promoted by the stimulus of 
bipolar faradization to the pelvic capillaries and lymphatics. 
Exactly the same plan of preparatory /oj«V?W and subsequent 
negative relaxing and softening applications is to be employed 
upon the thickened wall of the uterus and the tissues that hold 
it fixed. 

The vaginal electrode and the technique is the same, and all 
the work is done at the same time, by placing the external 
electrode in a position which conducts the current through all 
the affected tissues at once. By making the cotton wrapping 
of the carbon ball as large as can be inserted in the vaginal 
cavity a greater area of contact is obtained, and this has the 
double advantage of carrying a greater amperage (75 or more 
mil.) with comfort and acting upon a greater area of tissues 
than would a small electrode. 

In all these chronic and troublesome cases of complicated 
pelvic conditions when the first indication for either vaginal 
or intra-uterine treatment calls for sedative applications it is 
equally important to establish uterine drainage for the catar- 
rhal secretions, and to thin them if they are thick and ad- 
hesive, so that they will readily drain away. In such a state 
it would be useless to apply an intra-uterine positive current 
and expect sedative effects. The liquefying of the tenacious 
secretions and the cleansing of the mucous surface must first 
be accomplished by negative galvanic intra-uterine applications 
with mild currents varying from only 10 or 15 mil., if but little 
action is required, up to 20 or 30 mil., according to the neces- 
sities for greater liquefying action. The benefits of the positive 
current can then be obtained. 



TREATMENT OF UTERINE DISPLACEMENTS. 349 

When the uterus, if not replaceable in normal position at 
first, becomes more movable and can be partly or wholly sup- 
ported in its proper situation, the remainder of the galvanic 
portion of treatment will consist of positive galvanic applica- 



Fig. 95. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 

tions to the canal to restore a healthy state of the lining mem- 
brane and aid in imparting tonicity to the uterine body. These 
actions are assisted by the circulatory and vaso-motor stimula- 
tion of bipolar faradization and by slow muscular contractions 
by the monopolar method. 

These methods are so fully described elsewhere that they 
can be readily adapted in proper order of sequence to each in- 
dividual case by any practical physician who has also a practi- 
cal knowledge of medical electricity and possesses the necessary 
apparatus. 

The percutaneous galvanic method is also somewhat helpful 
in versions and flexions both recent and old, placing the posi- 
tive electrode in nearest relation to the fundus of the uterus 
and the negative opposite. This will tend to drive fluids from 
the positive to the negative region, lighten the uterus and 
exert a tonic effect upon the tissues. It starts a process which 
continues long after the current stops. It can be employed 
either before direct applications are begun, or when it is desired 
to temporarily suspend them if any reason for doing so arises. 

The final results of treatment depend on both the physician 
and his patient. If the patient does not persist, in a very 
chronic and aggravated case, until the utmost possible anatomi- 
cal restoration has been accomplished, she nevertheless will 
probably have derived very satisfactory or even complete 
symptomatic relief within a time which would be considered 
short by any physician employing other measures. 

If some partial return of troublesome symptoms occurs at a 



3S0 TREATMENT OF UTERINE DISPLACEMENTS. 

later period, it is not difficult to repeat the relief more quickly 
than at first, and as a practical clinical fact many women who 
suffer from pelvic lesions that will never be cured can be kept 
comfortable year after year by taking advantage of temporary 
electrical treatment whenever circumstances require. A symp- 
tomatic cure is almost certain. 

Uterine Conditions owing their Origin Directly or Indirectly 
to Relaxation of Tone of Muscular Fibre. — These common 
affections require for the most part vaginal bipolar faradic 
stimulation to nutrition, aided at first by suitable tampon sup- 
port after each treatment, if the patient has been accustomed 
to a pessary. A properly used bipolar electrode in the hands of 
every general practitioner who treats these pelvic conditions of 
women would banish fifty pessaries out of every hundred with 
unspeakable gratification to womankind. 




Fig. 96. A proper bipolar electrode. 

Attach the positive pole of the high-tension induction coil 
apparatus to the tip of the vaginal bipolar electrode. Make 
the opposite pole negative. Warm and lubricate the electrode 
with plain vaseline and insert it deeply into the vagina. It 
must be held steadily in position either by the operator or an 
assistant, or may be retained by the patient herself by means 
of the convenient handle devised by the author. 

If tenderness exists it must first be corrected by a sedative 
current. When this is removed commence more tonic treat- 
ment with the 800 yard No. 32 coil current maintained at full 
comfortable tolerance throughout entire sitting of ten minutes. 
When a marked increase in tolerance denotes the preparation 
of the tissues for final and vigorous stimulating effects, the 
management of the current will be found described under the 
head of bipolar stimulation in a previous chapter. 

The preparatory or sedative part of the early sittings in the 



TREATMENT OF UTERINE DISPLACEMENTS. 35 1 

treatment of t"hese cases should be not less than 15 or 20 
minutes, repeated every second day, or at least three times a 
week. If circumstances permit daily applications for a short 
time it will be advantageous to the patient. 

Tonic and nutritional applications can be limited to 15 or 
even 10 minutes if the current is managed skilfully. A great 
deal more depends upon a judicious technique than upon a 
given length of application. 

Stimulating and muscle contracting applications need not 
exceed five minutes, and in cases where no sedation is required 
the whole sitting need not exceed ten minutes. Of this time 
the first half may be devoted to the usual rapidly interrupted 
coil current, maintained but little short of maximum tolerance, 
and the latter half may be devoted to the swelling method of 
producing powerful contractions which I have described suf- 
ficiently under other headings. 

When a coil of 8cx) yards of No. 32 wire ceases to be effective 
and is scarcely felt with an E. M. F. of four or five cells, switch 
to the 500 yard No. 32 coil, and in time reduce this to the 300 
yard No. 32 coil before passing to the coils of coarser wire, 
although in all cases the practised operator rapidly selects the 
right coil with scarce a moment's delay. Tissues which at 
first were congested and tender will finally become so firm, 
healthy and hardy that they will tolerate a current' through 
only 100 yards of No. 16 wire coil with an E. M. F. of from 
three to four cells regulated through the rheostat. 

In the treatment of these cases the advantages of the large 
variety of coils which are now an essential part of a high 
efficiency induction apparatus are most admirably shown, for 
while the best common faradic battery is scarcely usable at all 
in gynecology the high efficiency induction apparatus will accom- 
plish results of priceless value. , 

While some of these results become commonplace to the 
few who appreciate the methods above described (for they are 
obtained with such readiness and facility as to no longer excite 
remark), yet they would be heralded as a remarkable advance in 



352 TREATMENT OF UTERINE DISPLACEMENTS. 

medicine if they could be procured by any other method em- 
ployed in either medicine or surgery. 

If a supporting tampon is advisable during the first week of 
bipolar treatment it will soon cease to be necessary and the 
patient rejoices at the fact. 

In the successful treatment and relief of symptoms of all 
forms of flexions, versions and prolapsus, as well as subinvolu- 
tion and the pathological conditions resulting, from it, this 
method of applying tonic electrical massage to the weakened 
muscular fibres is an important part of the necessary procedure. 
In cases which require the additional action of galvanic 
currents the faradic current is nevertheless often indispensable 
to the relief or cure. 

A bent uterus may be given superb exercise to strengthen 
its muscle fibres by inserting the intra-uterine bipolar electrode 
and employing a slowly interrupted coil current with dosage 
adapted to tolerance. It is perfectly comfortable to the 
patient. Short stances of three to five minutes are sulificient, 
repeated daily at first and later three times a week. 





Fig. 97. Intra-uterine bipolar electrode. (Faradic.) 

Uterine Prolapsus. — The treatment of any prolapsed condi- 
tion of the uterus resolves itself into the use of the galvanic 
current to reduce weight, and the faradic current to strengthen 
muscular supports. Even in aggravated cases, when the 
pelvic floor has been badly torn, with both cystocele and 
rectocele prominent, excellent palliative results can be rapidly 
obtained by the use of electricity alone. 

In a case of this kind I have seen pain and tenderness 
completely relieved at the first sitting and a dozen treatments 
restore to the patient the power to perform her household 



TREATMENT OF UTERINE DISPLACEMENTS. 353 

duties with comfort without any surgical operation whatever. 
Too much cannot be said of the comfort-restoring capabilities 
of electrical methods in these cases, for although an operation 
may be apparently necessary yet the patient may either object 
to it or be unable to have it performed. 

Methods of treatment are made sufificiently plain in dis- 
cussing other displacements and need not be repeated here. 
Always begin with bipolar faradization. Even if the patient 
needs and desires to have a perineum sutured it is better to 
precede the operation and put the tissues in the best possible 
state by a course of local treatment with electricity. 



±* 




NEGATIVE. 



Fig. 98. Intra-uterine tips for negative pole; 



Procidentia. — Mrs. , age 50. Procidentia, two inches, 

cystocele, rectocele, varicose vulva, bilateral laceration of 
cervix, laceration of perineum nearly to sphincter ani, uterine 
cavity 4j4 inches. Duration of lesions twelve years. 

I at once began vaginal bipolar faradic stimulation with 
short, coarse secondary coil. This had a marked effect, con- 
tracting the muscles so that the electrode could be felt drawn 
firmly upward. After the first application the uterus re- 
mained up for two hours. Repeated ten minute applications 
of the same nature every second day for the first month, 
at the end of which time the uterus did not come down at 
all. 

Mrs. now felt very much relieved and more able to do 

her work, but complained of a dragging, tired feeling when she 
remained long standing. The faradic current had strengthened 
the uterine supports, but had not lessened the weight to be sup- 
ported. 

I therefore began positive intra-uterine applications of the 
constant galvanic current with the platinum sound electrode, 
23 



354 



TREATMENT OF UTERINE DISPLACEMENTS. 



60 mil., for ten minutes every four or five days between the 
menstrual periods. After ten seances her period lasted only 
three days instead of eight as formerly. Three months later 
she reported that she was feeling better than ever before, 
and she certainly now looks ten or fifteen years less than her 
age. 

This is just one of a class of cases that come to. the prac- 
titioner's ofifice every day and which give (without electricity) 
a great deal of trouble and very unsatisfactory results. Most 
often they decline any operation and the time-honored pessary 
will not only not hold the uterus up but will not even hold 
itself in. For such cases the electrical treatment is most 
rational, for without cutting away any part of any organ it 
restores to the supports their lost tonicity, removes from the 
uterus its morbid weight, increases the vitality of the tropic 
nerves, and calls back into the circulation the morbid material 
stagnant in the tissues. 

In cases without hypertrophy the induction coil cur- 
rents will suffice to restore the prolapsed organ to its 
normal position, as I have witnessed many times ; but 
in other cases it is absolutely necessary to reduce the 
size and weight of the uterus by the action of the galvanic 
current. 

Other satisfactory effects in this case, which I have also 
noticed in many oth'ers, were the decided feeling of well-being 
after the galvanic application, and also the tonic action upon 
the bowels. {Smith.) 



A Surgical Discussion upon the Treatment of Retro-dis- 
placements of the Uterus. — Before considering the practi- 
cal utility and satisfactory service of electric currents prop- 
erly employed in the treatment of these common lesions it 
will emphasize the contrast between routine methods and 
electro-therapeutics to call to mind the ordinary recommenda- 
tions. 

Instead of advancing any personal opinion, however, about 
the value of some other measures it will be more forcible to 
quote from an advocate of one of the special surgical opera- 
tions who considers all non-electrical methods of treatment at 
some length in a recent Journal article, and omits to point out 



TREATMENT OF UTERINE DISPLACEMENTS. 355 

the demonstrated fact that electric currents will give the re- 
lief that is needed in almost every ordinary case. 

Perhaps there is no condition in the female pelvis which has 
occasioned more discussion than that of backward displacement 
of the uterus. We are told by nearly all writers that before 
taking into consideration any operative procedure for the 
cure of this affection we should, if possible, place the organ in 
its normal position by bimanual manipulation and retain it 
there for several months by means of pessaries or tampons until 
the round ligaments and other supports have had a chance to 
regain their natural tonicity. We are then told that should 
this fail we are justified in considering some operative treat- 
merit for the patient's relief providing the symptoms are suffi- 
ciently troublesome in warranting us in subjecting her to an 
operation. . 

I cannot agree with such advice. It is true that by means 
of bimanual manipulation, aided if necessary by the use of the 
sound or some form of uterine repositor, we can in simple cases 
in which no strong adhesions exist place the uterus in a fairly 
normal position. We can also by means of a well-fitting 
pessary or judiciously applied tampons, provided the pelvic 
floor is intact, oftentimes hold the uterus in position. • It is 
also true that by the long-continued use of such supports, com- 
bined perhaps with pelvic massage we can do much to improve 
the tone of the ligamentous supports of the uterus. The 
patient for the time being feels better, many of the trouble- 
some symptoms have been relieved, and, as she is not willing 
to submit to tamponing or wearing a pessary ad infinitum, we 
cease the tamponing or remove the pessary, and hope that our 
months of patient toil have not been in vain. We request the 
patient to return to us in a few months, in order that we may 
ascertain whether the uterus has remained in its normal posi- 
tion or not, and we are disappointed to find that usually it has 
not and that the patient begins to feel some of her old symp- 
toms returning. Then in desperation we advise the patient to 
have the condition cured by operation. She probably goes 
away from our office disgusted with us for having subjected 
her to months of futile treatment. Personally I think it would 
have been much more satisfactory if we had advised operation 
at the outset. We often find in our cases of retro-displacements 
some injury to the pelvic floor which weakens its supporting 
power, and before we can hope to keep our tampons or pessary 
in place it must be repaired, and when the patient must be 
subjected to operation for this the operation for the direct re- 
lief of the malposition may just as well be undertaken at, the 



356 TREATMENT OF UTERINE DISPLACEMENTS. 

same time. The use of pessaries, tampons, pelvic massage, 
etc., appear to me to be simply makeshift, giving, it is true, 
much temparary relief, but rarely if ever effecting a permanent 
cure, unless the patient is willing to wear some such support 
constantly. This being the case, it does not seem fair to me 
to subject our patient to troublesome treatment which promises 
so little, when we have at our disposal an operative measure 
which, if carefully performed, has no more risks than the ordi- 
nary plastic operations. 

Let us consider then the prominent operative procedures 
for the cure of retro-displacements. We have: 

1. Alexander's operation, by means of which the round liga- 
ments of the uterus are shortened extra-peritoneally. 

2. Wylie's and Dudley's operations, in which the round liga- 
ments are shortened intra-peritoneally. (Wylie scrapes the 
inner side of the round ligaments so as to make the surfaces 
raw, folds them external to the uterus, and passes three silk 
ligatures around each fold. Dudley, on the other hand, folds 
the ligaments in front of the uterus, and attaches each fold by 
two silk ligatures to the surface of the uterus.) 

3. Hysterorrhaphy, or ventral fixation, in which the fundus 
of the uterus is fastened to the anterior abdominal wall. 

4. Vaginal fixation, in which the fundus of the uterus is 
fastened to the anterior vaginal wall. 

In speaking of the Alexander operation I believe we have a 
better procedure and one which is more satisfactory in its 
technique and results. I would like briefly to enumerate 
some of the objections to the Alexander operation. . . . 

Wylie's and Dudley's operations while ingenious, and while 
they have the advantage over Alexander's operation in that, it 
being nece.ssary to open the abdominal cavity to perform theno, 
any existing adhesions may be broken up, have still but little 
to recommend them. In ventral fixation we have an operation 
which undoubtedly effects a permanent cure in cases of retro- 
displacement. It is doubtful however if so far as results are 
concerned it has much advantage over vaginal fixation. When 
vagino-fixation was first performed the sutures fastening the 
uterus to the vaginal wall embraced the fundus too high up, 
promoting possibility of complication at future pregnancy. 
As it is now performed I think it will interfere little if at all 
with pregnancy should this condition supervene. The possible 
danger in this operation is injury to the bladder, etc., etc., etc. 
{Wakefield.) 

When all suffering has been removed and a symptomatic 
cure effected by appropriate uses of galvanic and faradic cur- 



TREATMENT OF UTERINE DISPLACEMENTS. 357 

rents from improved apparatus the degree of malposition 
which remains becomes of no consequence to the patient. In 
these cases an anatomical restitution of the parts to the flawless 
state of childhood is too Utopian for practical physicians and 
their patients. A woman with a flexion which gives rise to no 
more symptoms generally feels satisfied with the results of 
treatment, and the physician who witnesses the satisfactory 
results achieved by electrical methods will feel little need to 
rely upon other means to relieve his patients who suffer from 
ordinary displacements and flexions. 

The reader who wishes to refer to the Carlet thesis on 
Electrical Treatment of Fibroids will find a great number of 
cases reported, not only of fibroids but also of endometritis 
and enlargement of the uterus, in which the organ was restored 
to its normal size. I have also reported a great many cases of 
displacement due to enlargement of the uterus which were 
cured by reducing the weight of the uterus by means of the 
continuous current and afterwards strengthening the support 
by the aid of a, coarse interrupted current. 

When the enlargement is due to subinvolution the inter- 
rupted current acts very well by setting up powerful contrac- 
tions of the uterine muscle, thereby cutting ofif the too great 
supply of blood to the sinuses and causing fatty degeneration 
and absorption of the superfluous muscular tissue. When the 
enlargement is due to areolar hyperplasia the interrupted 
current is useless as only the continuous current will cause 
absorption of fibrous tissue. {Smith.) 

The discussion of the relative merits of these operations 
must now be carried to a higher plane than that of mere 
technique and of immediate and remote anatomical results. 
Their greater or less interference with the functions proper of 
the uterus, child-bearing and child-birth constitutes the higher 
standard by which they must be judged. 

In pregnancies following vaginal fixation of the uterus there 
have been recorded : Disorders and pain in the vaginal 
cicatrix, abortions (twenty-five per cent, and over), vesical pain 
and disturbances of micturition, transverse presentation, pro- 
lapse of funis, very difificult version due to abnormal conditions 
established by vaginal fixation, severe post-partum hemor- 
rhage, rupture at site of cicatrix, delivery per vaginam im- 
possible, Porro operation, rupture of vagina, death from 
intra-peritoneal hemorrhage, etc., etc. . . . Other cases of 
serious disturbances of pregnancy and parturition were brought 



3S8 TREATMENT OF UTERINE DISPLACEMENTS. 

to light in the discussion, and anxiety was expressed for the 
ultimate fate of the already numerous victims of the yet young 
operation. Bockelmann estimated that there were in Berlin 
alone about one thousand women with the dire possibilities of 
vaginae-fixura gestation and delivery ahead of them. In New 
York there are perhaps two hundred such unfortunates. Who 
will dare to add to their number? With the evidence now-in, 
I will neither perform nor sanction in consultation vaginal 
fixation in a woman liable to future pregnancies. Mackenrodt, 
one of the originators and chief champions of vaginal fixation, 
has formally disowned the operation for the reasons just 
recorded. 

Applying to each of the three operations the crucial test of 
interference with the normal course of subsequent pregnancies 
vaginal fixation must be discarded altogether in women liable 
to future pregnancies, and vental fixation must be viewed with 
strong distrust. 

Neither vaginal fixation nor vental should be performed 
upon a woman liable to future pregnancies for the cure of an 
uncomplicated retroversion of the uterus. {Edebohls.) 



CHAPTER XXI. 

TREATMENT OF ENDOMETRITIS AND UTERINE INFLAM- 

MATIONS. 

Recent and simple endometritis. Endometritis in young girls. The treatment 
of chronic endometritis. Endometritis associated with slight metritis. En- 
dometritis complicated by a salpingitis or other peri-uterine inflammation. 
Hemorrhagic and fungous endometritis. A clinical hint. Catarrhal inflam- 
mation with profuse leucorrhoea. Chronic endometritis of the cervix with 
erosion, induration and unhealthy granulations. Chronic endometritis of 
the cervix with erosion, oedema and soft, swollen state . of the tissues. 
Chronic uterine hyperplasia with uterus large and soft ; with induration ; 
with extension of inflammation to the tubes and ovaries. Gonorrhoeal 
metritis. 

Recent Endometritis. — Recent and uncomplicated inflam- 
mation of the endometrium, or the body of the uterus, or of 
any pelvic tissue, requires no peculiar modifications of technique 
in electrical treatment but follows the usual rules of combat- 
ing inflammation anywhere. 

When the physician has prescribed appropriate auxiliary 
measures the chief local remedy for its sovereign power to 
relieve pain, to arrest acute inflammation and promote resolu- 
tion, is vaginal bipolar faradic sedation applied with proper 
apparatus and proper gentleness and persistence. Intra-uterine 
electrodes are contra-indicated. 

The use of an obsolete type of large, heavy, bipolar electrode 
and the current from a common faradic battery will be harmful. 
To benefit the case we must use the induction apparatus with 
improved rapid vibrator and fine coils, and the very light and 
correct form of electrode. 

The application requires only the care and prudence of reason- 
able skill to make it a sovereign remedy in acute pelvic inflam- 
mation. The indications for choice of coil, for duration of 

359 



360 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

stance and frequency of treatment are the same as those of 
acute, inflammatory and painful states elsewhere. 

Warm and lubricate the bipolar electrode, insert it gently to 
its greatest depth and let it be maintained in the most com- 
fortable position by the limbs of the recumbent patient. No 
assistance is required. 




Fig- 99- A proper bipolar electrode. 

Switch into current the perfectly adjusted rapid vibrator 
and 2,000 yards of fine coil. Switch an E. M. F. of four cells 
into action and control the current through the secondary 
circuit rheostat. Commencing at zero follow out carefully the 
principle of securing sedation and local anaesthesia by a current 
strength which is not only never painful but which becomes 
agreeably and progressively soothing. 

Maintain it at the point of comfort for a long time — fully an 
hour may be required at first — until it has relieved the pain 
and diminished the congestion and leaves the patient comfort- 
able after it has reduced to zero. 

When pain reappears some hours later repeat the application 
in the same way. While the galvanic current is not available 
in these acute inflammations and the faradic current was never 
available until it was refined and perfected by perfected ap- 
paratus, it is now a most important means of checlcing an 
inflammatory process and lessening the number of cases which 
become chronic. 

Simple Endometritis in Young Girls. — Percutaneous gal- 
vanic applications are often adequate treatment in these cases 
unless the condition has become too chronic and has progressed 
to metritis. Unless therefore some enlargement of the uterus 
is discovered external applications may constitute the treat- 
ment. 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 361 

Moisten a felt-covered, flat electrode, 7X 10, in the hot-water 
soda-bicarbonate solution, connect it with the positive pole of 
the galvanic battery and place it under the lower spine with 
the patient in the dorsal position on the operating table. 

Prepare a similar electrode in the same manner about 5X7, 
connect it with the negative pole and apply it with firm contact 




Fig. 100. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

over the hypogastrium. Retain it in position by the weight 
of a small shot-bag. 

Gradually increase the constant galvanic current from zero 
up to about 20 mil. In two minutes again increase the current 
and slowly reach the point of comfortable tolerance. In about 
ten minutes reduce gradually to zero, remove the electrodes, 
dust the skin with toilet powder and close the sitting. 

Repeat every second day between menstrual periods until 
recovered. It is obvious that this form of treatment may be 
employed before even a local examination is made, and in the 
class of cases in which it may suffice for treatment the local 
examination may be reserved until it is found to be necessary. 
Always prescribe hygienic and medical measures for the regu- 
lation of the abdominal and pelvic functions, so that all the 
resources of good therapeutics will be helping the patient at 
the same time. 

Chronic Endometritis. — Electricity in some form is abso- 
lutely indispensable to the treatment of chronic endometritis. 
To ignore this fact is about like ignoring quinine in malaria. 
Malaria can be treated without quinine but not so well. 



362 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

Auxiliary measures may be employed in the usual manner 
according to the indications of a given case. The technique of 
the electrical portion of the treatment is as follows : 

Begin at the first sitting with vaginal bipolar faradic seda- 
tion, and if congestion or inflammation of the peri-uterine 
tissues is sufficiently active and troublesome long sittings of 



Fig. loi. Bipolar vaginal electrode. 

20 or 30 minutes should be made daily instead of the routine 
three times a week. The first indication is to allay the irrita- 
bility and remove tenderness and pain. 

After the No. 36 coil ceases to be appreciable and the 800 
or 500 yard No. 32 coil with a full E. M. F. of four or five cells 
is thoroughly tolerated it may safely be assumed that the tis- 
sues are prepared for intra-uterine galvanic applications which 
are essential to the cure. 

There are now two variations of method, one advocated by 
Apostoli and the other known as metallic electrolysis. In some 
cases one is preferable to the other and will produce the 
quickest and best results, and in clinical practice the operator 
readily learns when to choose between them. 

The Apostoli method employs the positive polar action with 
non-attackable platinum electrode for short stances of five or 
eight minutes with a dosage of from 30 to 50 mil., or with 
shorter applications of about three minutes with higher inten- 
sities ranging from fifty to seventy-five and one hundred or 
more mil. at different stages in the treatment of different 
cases. 

Metallic electrolysis involves the use of oxydizable electrodes 
of zinc, copper or zinc amalgamated with mercury, with milder 
currents of from 1 5 to 30 mil. Metallic electrolysis is aseptic 
and germicidal and is employed chiefly for local and superficial 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 363 

effects upon mucous surfaces in states of catarrhal inflamma- 
tion. It is not employed for the deeper electrolytic action and 
for the active cauterizing effects which the Apostoli method 
may' be caused to produce by its increased dosage. 




Fig. 102. 

Whichever electrode and method is selected the end sought 
is nearly the same and the technique is practically .similar 
except in the regulation of the dose. 

It consists in either case of applying a large felt-covered, 
flat electrode, /X 10, externally upon the abdomen or sacrum 
(or both if above 60 mil. is to be used), inserting the positive 
electrode to the fundus of the uterus, switching the desired 
number of cells into circuit and gradually increasing the current 
through the rheostat from zero up to the desired dose, and 
after maintaining this for three, five or in some cases eight 
minutes reducing to zero and closing the sitting. 

The management of copper and zinc electrodes which adhere 
to the tissues is fully described under Metallic Electroly- 
sis, to which the reader is referred. 

The management of the Apostoli method with the platium 
intra-uterine electrode is the same in all cases for which it is 
used, whether chronic endometritis, chronic metritis, fibroid 
tumor or other lesion ; and the only difference relates to em- 
ploying different doses in different cases. 

If only a mild caustic and alterative effect is desired to cor- 
tect a superficial endometritis the dosage does not need to be 
increased above 20, 30 or 40 mil. If a gross destruction of 
morbid tissue is desired, as in the case of an advanced fibroid 
tumor, the dose must go to the highest possible tolerance and 
often reach the maximum employed in medicine. 

Between these two extremes of current action there is a wide 



364 ENDOMETRITIS AND UTERINE INFI-AMMATIONS. 

range of electrolytic work which calls for currents of from 40 
to 100 mil., and the physician who studies with some care the 
demonstrated physiological actions of the galvanic current will 
have little difficulty in regulating the dose in his cases of 
endometritis and benefiting the condition which appears. 

The sittings should not be oftener than twice a week when 
medium galvanic currents are employed, and not oftener 
than once in six or eight days when high intensities are used. 
Immediately after the galvanic electrodes are removed a short 
bipolar application should follow, and sittings devoted entirely 
to bipolar faradization should be made regularly about three 
times a week during the entire course of active treatment 
until pain and tenderness are removed. 

If in rare cases the uterine membrane contains fungi which 
require removal by the curette, the operation may advan- 
tageously be followed by positive galvanic cauterization of the 
surface. This controls the bleeding and starts up a healthy 
reaction. 

" There is no doubt that when properly used galvanic appli- 
cations constitute the most satisfactory and successful treatment 
of endometritis" is the concurrent testimony of every expe- 
rienced physician who speaks from practical work. 

The methods of metallic electrolysis are often so effective in 
catarrhal inflammations of mucous membranes and with mild 
currents that the use of 150 to 250 mil. so frequently advised 
a number of years ago is now superseded by simpler methods 
in the majority of superficial catarrhal inflammations. Very 
high dosage is rarely needed, and the general practitioner will 
be able to do most of his pelvic work with less than 100 mil. 
and a large percentage with less than 75 mil. 

Cataphoric Method. — It remains to describe an alternative 
application to the diseased mucous membrane which partakes 
somewhat of the nature of metallic electrolysis and is im- 
mensely superior to any superficial use of the tincture of iodine 
upon the surface by the time-honored applicator. 

Quite a variety of remedies (tincture of iodine, carbolic acid, 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 



365 



etc.) have been experimentally employed, but it is doubtful if 
a strong solution (ten to thirty per cent.) of iodide of potassium 
is not superior to them all. 

Moisten a felt-covered, flat electrode, about 6 X9, in the usual 




Fig. 103. 



Fine felt or sponge covered flat electrode — assorted ^izes with soft 
rubber insulating backs. 



hot-water solution of bicarbonate of soda, connect it with the 
negative galvanic pole and apply it either upon the lower ab- 
domen or under the sacrum. 

Wrap a light layer of absorbent cotton around the spiral elec- 
trode made especially for this purpose, connect it with the 



Fig. 104. Aluminium cataphoric uterine electrode screw tip. 

positive pole, dip the cotton in the iodide solution and insert 
it as desired. In cervical endometritis it may be applied only 
as far as the internal Os. In corporeal endometritis it should 
reach all the diseased membrane. 

Gradually increase the constant galvanic current from zero up 
to comfortable tolerance, which will develop in different cases 
from 25 up to 50 or 60 mil. 

The general principles of treatment conform to the usual 
rules. In some cases the method possesses advantages and 
appears to produce results superior to the action of the current 
alone. The same method may be employed in urethritis with 
about one-half the current strength. 

Simple Endometritis associated with Slight Metritis.— If 



366 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

menstruation is profuse, the first intra-uterine treatr 
should be with the positive galvanic current. If marked 
derness and other indications for bipolar faradic sedatior 
present commence the treatment with the vaginal bij 
electrode and the i,5cx3 yard No. 36 rapidly interrupted, 
ondary coil current as described \y!\6.&t faradic sedation. 

If there are no indications for delaying the direct treatr 
of the endometrium commence the second sitting with a n 
tive felt-covered, flat electrode, about 6x9, upon the abdo 




Fig. 105. Fine felt or sponge covered electrode — assorted sizes with soft 1 

insulating backs. 



Fig. 106. Long tin tip intra-uterine electrode. 

with a platinum or pure tin electrode connected with the 
itive pole and inserted carefully into the uterine canal. 

Gradually increase the constant galvanic current thn 
the rheostat from zero up to 10 or 15 mil. at the first sit 
If the case is a mild one and tolerance gradually increase: 
current strength may be slowly raised to 30 or even 40 
with sittings of about five minutes repeated twice a week. 

If however the condition is not associated with menorrh 
but on the contrary the indication is to favor drainage 
promote a freer discharge, the intra-uterine electrode shoul 
connected with the negative pole. The dose regulation 
other principles of technique are the same in either case. 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 367 

well-known indications for the positive current will always 
guide the operator to its selection, and the equally well-known 
indications for mild negative electrolytic and alterative action 
upon the diseased endometrium make the choice of this pole 
perfectly clear. The clinical results are good. 

Endometritis Complicated by a Salpingitis or other Peri- 
uterine Inflammation. — Whenever the first examination re- 
veals a fixed uterus and surrounding complication the intra- 
uterine treatment should be postponed until vaginal bipolar 
faradization and vaginal negative electrolysis have first allayed 
irritability, congestion, pain and tenderness if these exist and 
restored mobility to the uterus by softening and promoting the 
absorption of exudates. The exact methods of technique have 
been so frequently described in other places that they need not 
be repeated here. See chapter on Peri-UTERINE INFLAMMA- 
TION. When the cotton-wrapped carbon ball electrode can be 




Fig. 107. Carbon ball electrode. 

employed directly upon adhesive fibrous bands with about 75 
mil., the softening and relaxing effect is very rapid. Attack 
pain first, immobility next and finally the uterine canal. The 
vaginal hydro-electric douche can be employed before the 
carbon ball is tolerated. 

Hemorrhagic and Fungous Endometritis. ^At the first 
sitting employ vaginal bipolar faradic sedation if the patient 
is not in immediate need of measures to arrest hemorrhage. 




Fig. 108. Bipolar vaghial electrode. 



368 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

If any pain, tenderness or other indications exist for continu- 
ing the induction coil current the bipolar method should be 
repeated at least every second day until the patient is prepared 
to accept the essential curative treatment which is the positive 
intra-uterine galvanic current. " 

The amount of preparation necessary before commencing 
intra-uterine treatment may be only a single bipolar applica- 
tion in one case, while in other cases the patient may be in a 
state which requires an intermediate use of the galvanic current 
by either the percutaneous or vaginal methods. 

The activity of the intra-uterine dosage when the positive 
current is employed is governed by the activity of the bleeding 
until this is thoroughly controlled. If there is merely a rather 
profuse menstruation the dosage will be moderate, w;hile if 
there is an actively bleeding surface the treatment must push 
the astringent action of the positive pole to the point of maxi- 
mum tolerance. It thus acts as a " chemical curette." 

The value of the positive galvanic current in stimulating 
contraction and interstitial absorption after the bleeding is 
arrested makes it the best remedy for all varieties of conditions 
classed under this heading. As the management of the case 
follows the general principles of treatment it is not necessary 
to repeat the directions here. It is sufficient to say that prob- 
ably no other method will be so certain of action, so free from 
risk and so satisfactory to the patient. 

■ In all intra-uterine applications begin with a small amperage 
(15 to 25 mil.) and test the tolerance before employing high 
intensities. If fungosities still bleed have the curette used 
and then proceed with positive galvanism. 



Remarks. — Intra-uterine positive galvanic applications of 
from 50 to ipo mil., in cases of endometritis, metritis, etc., set 
up decided contractions and shut down the uterus on the elec- 
trode so that in withdrawing it the tissues may seem to hold 
it in a firm grasp. Always use care in removing it and reverse 
the current if necessary. 

The negative polar action does the opposite of this, relaxes 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 369 

the tissues, makes the canal more patulous and causes a creamy 
discharge by its alkaline electrolysis. 



Catarrhal Inflammation of the Lining Membrane of the 
Uterus with Profuse Leucorrhcea. — Begin treatment, as usual 
in all cases associated with pain and tenderness, by vaginal 
bipolar faradic sedation and continue with this until conges- 
tion, tenderness and acute symptoms are allayed. Daily 
applications hasten these results in private practice, although 
clinic patients are rarely treated oftener than three times a 
week. 

When the patient is ready for direct local treatment of the 
catarrhal condition the first step requires free drainage. If the 
canal is constricted in any part, or if the secretions are too 
thick and tenacious to drain away, the preparatory application 
of the negative galvanic current with an intra-uterine sound 
and 15 or 20 mil. for eight or ten minutes is necessary. This 
may be repeated two or three times if otherwise the conditions 
would prevent the essential contact of the positive electrode 
with the clean and free surface of the mucous tissues. 

The curative intra-uterine treatment to follow these pre- 
paratory measures consists of (i) positive galvanic applications 
of mild dosage 20 to 40 mil. for five or eight minutes with a 
plantum electrode, repeated three times a week, or (2) 
metallic electrolysis, repeated at intervals of from four to 
six days until improvement ceases. 

Cupric electrolysis is preferred when a soft and boggy state 
of the tissues exists, zinc in sclerous conditions, and zinc amal- 
gam when the discharge is muco-purulent or purulent. 

Both copper and zinc electrodes adhere to the tissues when 
held stationary during the action of the galvanic current and 
must be loosened by reversing the polarity at the close of 
the application. Zinc amalgam does not adhere, and possesses 
also the advantage of a lubricated surface which enters readily. 
The methods are practically alike in details of administration 
apart from the different dosage employed. 



370 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 




Fig. 109. Fine felt or sponge covered, flat electrode — assorted sizes with soft 
rubber insulating backs. 

Place a large felt-covered, negative electrode upon the abdo- 
men or sacrum, and usually these positions should be alternated 
during any extended course of treatment for most pelvic affec- 
tions of a chronic nature. 

If either the platinum intra-uterine electrode, or one of 
copper, zinc or zinc-amalgam is selected, connect it with the 




^JOjper Ji 



Fig. no. Zinc and copper tip intra-uterine electrode. 

positive galvanic pole and insert it to the fundus of the uterus 
in the usual manner. If it does not readily enter the canal in 
any case, it is always a neat point in practice to carry the elec- 
trode into the canal with the aid of about ten mil. of negative 
current, which may be at once reduced to zero after it has 
served its purpose. 

With the electrodes now in position increaise the positive 
galvanic current through the rheostat from zero up to a dos- 
age which different degrees of tolerance (as improvement pro- 
gresses) will carry along from 20 to 30 or 40 mil. Maintain the 
maximum current for five minutes. Whenever a milder dosage 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 37 1 

is found to lack effectiveness at any stage of treatment larger 
currents can be used with either the platinum or zinc-amalgam 
electrode, but the need of an amperage much above 40 mil. is 
exceptional in this class of cases. 

If complications exist with the catarrhal condition they will 
require other measures, but in simple cases a couple of months' 
treatment between menstrual periods will produce satisfactory 
improvement. 

Chronic Endometritis of the Cervix, with Erosion, Indu- 
ration and Unhealthy Granulations. — Commence treatment 
with vaginal bipolar, faradic sedation, and if local tenderness, 
inflammatory or neurotic disturbances require a course of 
preliminary treatment continue bipolar sedative and sedative- 
tonic applications p. r. n. 






-^^K 



Fig. III. A proper bipolar electrode. 

As soon as the active local treatment can begin (and at the 
second sitting if nothing else interferes) place a large felt- 
covered, flat electrode, 7 X 10, upon the abdomen or under the 
sacrum and connect it with the positive pole of the galvanic 
battery. 

Select a bare metal electrode-sound of sufficient size to make 
contact with the whole cervical canal. After adjusting the 




Fig. 112. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 



372 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 



Fig. 113. Intra-uterine electrodes. 

speculum and cleansing the parts with creolin or carbolic so- 
lution insert the electrode within the canal, connect it with the 
negative pole and increase the constant galvanic current 
through the rheostat from zero up to about 15 or 20 mil. at 
the first sitting. Maintain for five or eight minutes and reduce 
to zero. 

Change the sound electrode to the largest blunt tip of the 
copper or zinc set and treat the eroded tissues around the ex- 




Fig. 114. Short copper or zinc bulbs. 



ternal Os with a current of about 15 mil. Hold the blunt end 
of the electrode stationary upon each part it covers for about 
one minute and slowly rotate it over all the diseased area until 
the entire surface is treated with negative electrolysis. 

Repeat these applications at intervals of from four to six 
days according to the progress of the case. 

So long as the general condition of the pelvic structures de- 
rives benefit from the sedative-tonic, nutritional bipolar fara- 
dization, increased in dosage as improvement permits increas- 
ing stimulation, follow each galvanic sitting with about ten 
minutes of the coil current. 

If the galvanic applications are a week apart two inter-current 
bipolar treatments may be given with decided advantage. 

The practical merits of this plan will be apparent in the gain 
in the general health, sleep, appetite, nutrition and composure 
of the patient, and these benefits will in turn help nature to 
repair th.e local damage. The bipolar application treats the 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 373 

patient rather than the cervix, but is worth far more than a 
host of other topical remedies which are extravagantly praised. 

In any aggravcited case the patient should be under observa- 
tion three times a week, and treated with the bipolar induction 
current and such other measures as can be employed to fulfill 
the indications. 

The- second galvanic application to the cervical canal, will 
permit an increase of the dose to 20 or 25 mil., and if this is 
well tolerated the operator at the next sitting is able to go to 
40 or 50 mil. ; he is assured of safety in rapidly increasing the 
dose beyond electrolytic and caustic effects into a cauterizing 
current, to soften the tough superficial tissues, cut down un- 
healthy granulations and establish a healthy reaction. 

As soon as this is effected and proper vascularity begins to 
show on the erosion wait to observe the extent of healing be- 
fore cauterizing the surface again. Three or four thorough 
negative applications of as strong a current as proper cauteriz- 
ing action requires will generally stimulate the healing process 
except in some fissure or limited area which has not come fn 
contact with the electrode. Special applications should be 
made to these upon the same principle, but with the metallic 
surface of the electrode fitted to close contact. After obtain- 
ing a satisfactory start the applications to the cervical canal 
may be made about once a week for continued galvano-caustic 
effects until satisfactory improvement is obtained. 

Chronic Endometritis of the Cervix, with Erosion, (Edema 
and Soft, Swollen State of the Tissues. — As induration is 
often a keynote to the choice of the negative galvanic polar 
action, so is the opposite state a keynote for positive polar 
action. Indeed the cases are not few in which the conditions 
are so associated as to call for inter-current applications of the 
polarity which is not indicated in chief, and the fact that both 
polar actions harmonize with physiological efforts of nature to 
restore the sound state simplifies the matter of selection for 
the physician. When there is present one or more of the 
major indications for either positive or negative galvanic 



374 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

action there is seldom &ny liability of harm resulting to the 
uterine tissues, and the probability of benefit beyond the mere 
local indications is very great. (See chapter on GALVANIC 
Electro-physiology.) 

Begin the treatment of the patient with vaginal bipolar 
faradic sedation as usual in almost all cases of pelvic disease. 
Close the sitting with a carbolic and glycerine tampon, and 
employ any other aid to treatment which the local or general 
state of the patient calls for. When local tenderness and irri- 
tation have been sufficiently controlled by bipolar faradic 
applications (or if they have not been present), the galvanic 
part of the treatment may begin. 

If the canal is filled with tenacious mucus that will not 
readily come away, and if some induration of the surface 
exists, the first polar action indicated is the negative, to prepare 
the tissues for the essential action of the positive pole. The 
technique of dealing with these states which require negative 
electrolysis is described in other sections. 

So many pelvic diseases embody several complications, each 
of which can always be treated from a single description of the 
technique, that it is not necessary to repeat every detail under 
each heading in these chapters. The basic principles which 
guide the physician in the uses of electric currents are exceed- 
ingly simple and require scarcely more than the possession of 
good apparatus and a little clinical practice, in addition to 
ordinary medical training. 




Fig. lis- Fine felt or sponge covered' electrode — assorted sizes with soft rubber 

insulating backs. 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 3;5 

As soon as the surface is clean, relaxed and prepared by the 
negative current, proceed to apply the positive current in about 
the same manner, except that a platinum electrode must be 
used. Employ the usual felt-covered, flat electrode upon the 
abdomen and connect it how with the negative pole of the 
galvanic battery. Insert the speculum and cleanse the parts 
with the usual creolin or carbolic solution. Sterilize the plati- 



Fig. n6. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 

num electrode with the alcohol flame, connect it with the 
positive pole and insert it to the requisite depth of the diseased 
canal. 

Increase the constant galvanic current through the rheostat 
from zero up to the point of comfortable uterine tolerance 
and after five or eight minutes reduce gradually to zero. 
While the dosage at first may be only 25 mil. it will speedily 
increase to 50 mil., but higher amperage than this will rarely 
be required, for a caustic and alterative action is needed rather 
than the cauterization of large currents. If, however, the 
particular case presents exceptional conditions, the experienced 
operator who knows the effects he seeks will push his dosage 
until he gets the effects, however obstinate and chronic the 
case may be. 

The uses of antiseptic and astringent or depleting tampons, 
the auxiliary aid of bipolar faradization and other rational 
measures for the benefit of the patient will suggest themselves 
to the physician, and should be employed as needed during the 
course of treatment. The remedy in chief is the galvanic 
current. 

Chronic Uterine Hjrperplasia, with Uterus Large, Soft, 
(Edematous, Sensitive to Pressure and Easily Bleeding. — 
Begin treatment with vaginal bipolar faradization every second 
day. Daily sittings during the first week of- treatment are 
better still. Switch into circuit the rapid vibrator, four or five 



376 



ENDOxMETRITIS AND UTERINE INFLAMMATIONS. 



cells and the 1,500 yard No. 36 coil, and with the aid of the 
rheostat increase the current strength from zero up to the 




Fig. 117. Bipolar vaginal electrode. 

point of producing a gentle grasp upon the ti-ssues, accom- 
panied by an increasing sense of comfort. No matter what 
coil or E. M. F. produces this effect, the current must be in- 
creased from zero until the correct dosage is found. 

Continue these applications with a gradually increasing 
stimulus to absorption and contraction as rapidly as sedation 
prepares the parts. 

Either at the beginning if it is necessary, or at any other 
time it may be required in any given case, free drainage may 
be assisted by a few applications of intra-uterine negative 
electrolysis, with mild currents of from 15 to 30 mil. 

The direct indication for the general condition of the uterus 
is the anti-congestive, alterative, astringent, muscle-strengthen- 
ing action of the positive galvanic current. The galvanic part 
of the treatment may be begun as soon as the vaginal bipolar 
method accomplishes its work of preparation of the parts by 
removing tenderness and irritability. 

Place the usual large felt-covered, flat electrode, 7X 10, upon 




Fig. 118. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 377 

the abdomen and connect it with the negative pole. Burn off 
the surface of the positive platinum or pure tin electrode with 



J<IDDER 1 
Fig. 119. Long tin tip intra-uterine electrode. 

the alcohol flame in the usual manner, and insert it so that 
metallic contract will be made with the entire uterine canal, 
from the external Os to- the fundus. 

Gradually increase the current strength through the rheo- 
stat, from zero up to the point of comfortable tolerance, which 
may be between twenty and forty mil., in the early treatment 
of the case. 

These milder applications may be made twice a week, fol- 
lowed, as usual, with five or eight minutes of supplementary 
bipolar faradization with currents which become increasingly 
tonic with the progress of improvement. 

After improvement permits the use of 50 mil. with the intra- 
uterine electrode, the conducting area of the external electrode 
should be increased in the usual way, by placing a pad upon 
both the abdomen and sacrum and connecting them to the 
negative pole with a bifurcated cord. 

The intra-uterine current should now be pushed as rapidly 



Fig. 120. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No.' II, French. 



as possible up to about 100 mil. Maintain the maximum dose 
for three or five minutes during each sitting and reduce gradu- 



3/8 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

ally to zero. Insert a glycerine tampon after treatment and 
also dust the skin beneath the external electrode with toilet 
powder, to remove any temporary irritation. 

Repeat these applications of doses above 50 mil. only once 
in from four to six days, allowing the effect of each to fully 
mature before the repetition. Inter-current treatment should 
be bipolar faradization. 

After absorption of the excess of fluids in the tissues by the 
combined action of the osmotic, cataphoric and electrolytic 
properties of the positive galvanic current, the vigorous and 
stimulating vaginal bipolar faradic application, which will now 
be safely tolerated, will aid to shrink down the uterus and 
impart tonicity to its own muscular fibres and supporting 
structures. The patient will rapidly improve. The galvanic 
current lightens and reduces the uterus and the coil-current 
tones up the muscular supports. 

Chronic Uterine Hyperplasia, with Induration. — For 
this obstinate condition persistent intra-uterine negative 
electrolysis and vaginal bipolar faradization are indicated as 
the chief measures. 

Commence treatment with the usual vaginal bipolar test of 




Fig. 121. Bipolar vaginal electrode. 

the tolerance of the tissues to allay irritability, tenderness 
and congestion, and establish the composure of the patient. 
The indications for the regular, systematic use of this method 
with gradually increasing dosage are the same as usual, and 
the reader is now familiar with them. 

After the routine preliminary preparation of the parts for 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 379 

intra-uterine applications the first galvanic sitting should 
always employ the positive pole. I believe this to be a judicious 
rule for the general practitioner to follow, because of the 
advantages which the action of this pole affords in determining 
the state of the uterine and adjoining tissues and in preparing 
tolerance. 

If the first application demonstrates a normal tolerance we 
may begin at once at the next sitting with the essential soften- 
ing, liquefying and absorbing action of the negative pole. If 
intolerance to more than a small current demonstrates sub- 
acute inflammation which must be allayed before taking the 
next step, the treatment of this complication by measures de- 
scribed under a separate heading must precede active electrol- 
ysis. (See Pelvic Peri and Para Metritis.) 

The judgment obtained by a little practice with these methods 
instructs the physician when he can safely proceed to attack 
the indurated hyperplasia. 

Place large felt-covered, flat electrodes, 7X lO (well saturated 




Fig. 122. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

with the invariable hot-water solution of bicarbonate of soda), 
upon the lower abdomen and under the sacrum and connect 



JtlDDER 

Fig. 123. Long tin tip intra-uterine electrode. 



380 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 



Fig. 124, Positive electrode with sliding shuttle. 

them to the positive pole of the galvanic apparatus. As the 
negative galvanic current does not attack metals, the intra- 
uterine electrode-sound may be selected solely with reference 
to suiting the size of the canal. The metallic part should 
make thorough contact from the external Os to the fundus if 
the cervical tissues are diseased. 

Increase the constant galvanic current through the rheostat 
from zero up to the point of the greatest uterine tolerance 
which can be secured at each sitting, until this advances to 
about 100 mil. Maintain the maximum current for three to 
five minutes, and reduce the current gradually to zero. It is 
a good rule to at once devote five minutes to a vaginal bipolar 
application and close the sitting with a glycerine tampon. 

Prescribe other internal and hygienic measures indicated by 
the condition of the patient, and in chronic uterine diseases do 
not expect electricity to do the entire work unaided by other 
medical resources, although in a clinic where no prescribing is 
allowed, the average results of electrical treatment are surpris- 
ingly good. 

Catarrhal Metritis, with Extension to the Tubes and 
Ovaries. — The principles governing the treatment of these 
cases follow the familiar indications for the choice of current 
and polarity already described in these pages. If the affection 
exists, as it oTten does, in the stages prior to constitutional 
involvement, local applications will be sufficient. The patient 
whose general health has not yet suffered very seriously will 
obtain satisfactory improvement under purely local methods. 

But when the physical organization has suffered and the 
local symptoms are accompanied by nervous disturbances and 
profound depression, it is necessary to treat the patient as well 
as the disease. Here it is that the static machine becomes of 



ENDOMETRITIS AND UTERINE INFLAMMATIONS. 38 1 

the utmost importance to the gynecologist. It requires but a 
few moments to treat the uterine canal with the galvanic cur- 
rent, but to pursue and conquer the array of symptoms and 
migratory disorders which some of these cases present with the 
localized electrodes of galvanic and faradic methods is not a 
practical task. The rest cure is futile as a therapeutic meas- 
ure, and surgery and drugs alike disappoint. 

The local methods described in these chapters and rein- 
forced by the resources of static electricity will generally yield 
results in these cases " without a parallel in any other remedy. 
Cases due to puerperal infection, even though of some years' 
standing, will respond quickly. GonorrhcEal cases are slower 
if seen in late stages, particularly if there be extension to the 
tubes ; in these a symptomatic cure will often be marred by 
the continuance of the leucorrhoea for some time." 

In all these cases with extension to the tubes and ovaries 
the degree of intensity of the salpingitis guides us to either an 
entire reliance at first upon the vaginal methods — both of the 
galvanic and induction coil currents — or directs the conserva- 
tive intra-uterine applications until improvement progresses 
and tolerance becomes established, so that a more active dosage 
can be employed. 

Gonorrhoea! Metritis. — One of the most instructive medical 
books that could be written would apply the " parallel column " 
method of modern journalism to electro-therapeutics and thera- 
peutics not electrical. It is suggestive to compare positive 
galvanism or metallic electrolysis with the permanganate 
douches, the methylene blue paint, the ice-water coil, the 
leeches and. opiates, the nitrate of silver, the laminaria tents, 
the uterine packing, and finally the excision of the mucous 
membrane and destruction of Skene's and Bartholin's glands 
which a pro-minent medical journal of Jan. 25, 1897, places as 
follows before its readers : 

Diagnosis and Treatment of Gonorrhoea! Metritis.— The 
diagnosis of gonorrhceal metritis can be made by digital ex- 
amination and the speculum. The chief signs for differentiat- 



382 ENDOMETRITIS AND UTERINE INFLAMMATIONS. 

ing it from other forms are the normal appearance of the cervix 
and the smallness of the external os. 

Gonorrhoea being a local infection, all intra-uterine manipu- 
lations are contra-indicated, such as passing sounds, dilating 
and washing with antiseptic solutions. Above all, the curette 
is the most dangerous therapeutic procedure. It opens the 
way for absorption of the gonococci into deeper structures and 
is often followed by rise of temperature, pain in the lower 
abdomen, and may go on to a true peritonitis or infection of 
the joints. 

In acute cases, when only the cervix is involved, the patient 
should be put to bed, given warm douches of permanganate of 
potash twice a day, and the interior of the cervix painted over 
gently with methylene blue, care being taken not to pass the 
internal os. If the uterus is involved, the patient should be 
put to bed, an ice-water coil applied to the abdomen, and 
douches of mild antiseptics given. The pain may be relieved 
by leeches applied to the perineum and opiates by the mouth. 

After the acute symptoms have subsided, the cervix may be 
touched with nitrate of silver and vaginal tampons inserted. 
If the uterine cavity is involved, the cervix should be dilated 
widely with laminaria tents and the cavity of the uterus packed 
with gauze dipped in glycerine and creosote or naphthol-cam- 
phor. Cases of inveterate endocervicitis require excision of 
the mucous membrane. At the same time the foci of infection 
in the urethra, Skene's glands and Bartholin's glands should 
be destroyed. 



CHAPTER XXII. 

TREATMENT OF SOME OF THE LESIONS OF THE CERVIX. 

Neglected minor lacerations of the cervix. Erosion of the cervix. Ulcerations 
and non-malignant degenerations of the cervix. Stenosis of the internal Os. 
Clinical case. To soften the indurated angle of a sharp uterine flexion. 

Neglected Minor Lacerations of the Cervix. — Galvanic— 
Many reflex nervous symptoms and local morbid states have 
been attributed in the past to neglected lacerations. 

Surgical repair does not always relieve the symptoms, and in 
a great many cases the lesion in its chronic stage seems too 
insignificant to warrant any attempt to operate. 

All these minor scar tissues (which cannot be certainly im- 
proved by an operation or excision) can be satisfactorily soft- 
ened and the symptoms relieved by negative electrolysis 
employed in the following manner : 

Place a felt-covered flat electrode, ^ X lO, upon the abdomen 




Fig. 124a. Fine feU or sponge-covered electrode— assorted sizes with soft rubber 

insulating backs. 

and connect it with the positive galvanic pole. Insert a 
speculum and swab out the vagina with the usual creolin or 

383 



384 TREATMENT OF THE LESIONS OF THE CERVIX. 



carbolic solution. Connect with the «^^tfi??Wpole one of the set 
of metallic tips or olives which will fit best in contact with the 



im 



lis 18 21 14 27 30 33 36 




Fig. 125. Zinc and copper tips for metallic electrolysis. 

scar. Hold it steadily against the cicatrix and increase the 
constant galvanic current through the rheostat from zero up 
to ten or fifteen mil. according to the size of the metallic tip 
employed. The larger the tip the more current can be used. 

Maintain the softening and healing action for about ten 
minutes and reduce the current gradually to zero. 

With the speculum still in place pack a protecting cotton 
tampon soaked in a solution of soda-bicarbonate under and 
around the cervix leaving the cicatrix exposed. Spread apart 
the lips of the laceration. Have at hand a small bottle of 
nitric acid C. P. diluted with nine parts of water, making a ten 
per cent acid strength. With a hardwood stick such as watch- 
makers use, or a glass rod, apply the dilute nitric acid to the 
lacerated surface which has just been electrolyzed. As soon 
as a film forms neutralize the acid at once with soda-bicarbon- 
ate solution and not only swab the cicatrix to arrest the action 
of the acid but' use care to avoid letting any of the acid run 
down upon the' other tissues and burn them. Remove the 
tampon at close.- 

Repeat this application about once a week between menstrual 
periods. In a few months it restores the tissues to practically 
normal in cases which are not too difficult to treat by this 
method. It also successfully corrects cases which appear to 
be incipient epithelioma. The patient with irritating scar 
tissue of the cervix procures a normal cervix and thus far 



TREATMENT OF THE LESIONS OF THE CERVIX. 385 

restored health by this method. Associated conditions must 
also receive due attention as well as the general health. 

Erosion of the Cervix around the External Os. — Galvanic. 
— Negative galvanic applications are followed by rapid healing 
of the surface in practically all simple cases. The condition 
usually exists with associated lesions which also require treat- 
ment, and the application to the erosion constitutes only a part 
of the regular sitting. 

With the usual felt-covered flat electrode, 7X 10, upon the 
abdomen or sacrum and connected with the positive pole, select 
a large size blunt tip from any one of the sets employed for 
metallic electrolysis. Whether the metal is copper or zinc is 




Fig. 126. Short copper or zinc bulbs. 

of no moment, for it is not affected by the current and is 
selected only with regard to convenient size and shape. Con- 
nect it with the negative pole and place the blunt metal end 
against the eroded tissue. Increase the constant galvanic 
current through the rheostat from zero up to about 15 mil, 
maintain for three or five minutes, slowly moving the electrode 
over all the denuded part, and reduce to zero. Repeat 
again at the next sitting and as the surface gradually heals 
make the application only to the parts which still remain un- 
healthy. 

If the tissues are thickened and tough, and preserit excess- 
ive granulations, these must be cut down by a few applications 
of the same method with the dose increased to 35 or 30 mil. 
In all cases the physician has only to look at the surface to 
know exactly what the application should be. Repeat until 
healthy tissue is established. 
25 



386 TREATMENT OF THE LESIONS OF THE CERVIX. 

A variation of the galvanic method employs the hydro- 
electric douche electrode. 

Douche. — Moisten a felt-covered, flat electrode, 7X lO, in a 
one per cent, hot water bicarbonate of soda solution and apply 
it upon the abdomen with the patient in the dorsal position on 
the operating table. Connect this with the positive galvanic 
pole. 

Prepare about three quarts of any preferred alkaline and 
antiseptic solution in the irrigating jar, placed at a sufficient 
height to administer an ordinary vaginal douche. Attach the 
end of the rubber tube to the vaginal electrode and connect 
the electrode with the negative galvanic pole. Have the water 




Fig. 127. Electrode for vaginal hydro-electric applications. 



hot. When the electrode is inserted turn the stop-cock of 
the rubber tube and allow a continuous flow of the solution. 
Immediately regulate the constant galvanic current from zero 
up to tolerance, and maintain the current until the irrigator 
is empty or for fifteen or more minutes. 

Ulcerations and Non-malignant Degeneration of the Cer- 
vix. — Galvanic— Y\z.ze. the usual felt-covered, flat electrode, 
6 X 9i upon the abdomen or under the sacrum. If any cysts or 
hard nodules are discovered upon inspection of the tissues 
through the speculum connect a lance-pointed large needle 



TREATMENT OF THE LESIONS OF THE CERVIX. 



387 



with the negative pole and plunge it into the cyst about an 
eighth or quarter of an inch. Switch into action the constant 



Fig. 128. 




Fig. 129. Fine felt or sponge covered electrode—assorted sizes with soft rubber 

insulating backs. 



current and pass about 7 mil. until a white froth bubbles out 
around the electrode and the nodule is destroyed. 

Repeat process upon each nucleus that exists. The patient 
is almost unaware of the process as it is perfectly painless and 
consumes scarcely more than a minute for each puncture. On 
withdrawing the needle the tissues close and heal so readily 
that on the next examination a few days later there will 
usually be no trace left. 

Treat each ulcerated patch with negative electrolysis to 
promote nutrition and healthy granulation. If the ulcer is 
just commencing puncture it and treat as directed above. If 
the tissues are already broken down and form an ulcerated 
patch apply the negative current through the blunt tip of the 
largest of the set of copper or zinc electrodes in the same 
manner as directed for erosions of the cervix. 

If the tissues are soft and irritable, bleed easily, and present 
these familiar indications for the positive pole select the largest 
copper tip and place it against the tissues with the negative 



388 



TREATMENT OF THE LESIONS OF THE CERVIX. 



pole now- connected with the electrode on the abdomen or 
sacrujn. Increase the constant current through the rheostat 
from zero up to about 15 mil. or the point of comfortable toler- 
ance. Keep the copper tip in close contact with the tissues 
but prevent adhesion by very gentle rotation over the parts 
until every portion is attacked by the oxychloride of copper 
deposit. After eight or ten minutes close the sitting with no 
other similar treatment for a week. 

At the next examination observe the effect of the cupric 
electrolysis and repeat with such modification as the tissues 
indicate. As soon as the tissues appear to be ready to take on 
healthy granulation cease the metallic electrolysis and with 
the same electrode freshly polished and connected with the 
negative galvanic pole encourage healthy nutrition by mild 
applications of ten or fifteen mil., about twice a week. 

Stenosis of the Internal Os. — Galvanic. — To dilate a narrow 
or constricted Os producing irritation, or preventing uterine 
drainage, we have an all-sufficient remedy in negative galvanic 
electrolysis with mild currents. This condition was at one 
time supposed to be a prolific cause of dysmenorrhcea and 
mechanical dilators were frequently employed to tear apart 
the fibres. The results of mechanical dilatation were as 
unsatisfactory as they deserved to be, for the method is bar- 
barous and needless. 




Fig. 130. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 



TREATMENT OF THE LESIONS OF THE CERVIX. 



389 



Place z. positive felt-covered, flat electrode, 6X9, either under 
the sacrum or upon the lower abdomen and maintain it in firm 
contact. To the negative terminal of the galvanic battery con- 
nect either a uterine electrode-sound of medium size, or em- 
ploy one of the assorted olives which are made for this 
purpose. 




Fig. 131. Intra-uterine electrode — assorted size tips. 

After engaging the cervix with the speculum arid cleansing 
the parts insert the tip of the negative electrode gently into 
the canal as far as it will go without pressure. Support it in 
this position and slowly increase the current through the 
rheostat up to 5, 7 or 10 mil., spending at least five or eight 
minutes in the process if the olive does not pass the obstruction 
in less time. 




Fig. 132. Set of olive tips. 




Handle for same. 

When dilatation has been accomplished the electrode will 
glide into the canal as if drawn forward by suction. It requires 
no pressure and the electrode should simply be directed and 
supported. 

Having begun with a small olive repeat the application with 



390 TREATMENT OF THE LESIONS OF THE CERVIX. 

a larger size at intervals of a couple of days until the resu] 
desired is accomplished. The dilatation is accomplished wit 
ease to the operator and without sensation to the patient. It i 
usually permanent or becomes so during the course of treat 
merit. If a repetition of the process is ever required at som 
future time it is as simple as at first. 

While mechanical dilatation has been severely condemned 
both by its failure to benefit the patient and by the judgmen 
of judicious pbysicians, the advantages of negative electrolysi 
over tents, dilators and the knife are : 

1. The process is painless, harmless, unaccompanied b; 
shock, and is the acme of simplicity. 

2. It represents the least possible trouble to physician an( 
patient. 

3. There is no destruction of the endo-cervical mucosa, o 
rupture of muscular fibres, and therefore no subsequent cica 
tricial contraction. 

4. It is not followed by disturbing sequelae, for it is so gent I 
a process that the patient is not even aware from her sensation 
that it is being done. 

5. There is no liability of sepsis, for there is no injury to thi 
tissues. 

6. It does not require the patient to spend .a moment in bee 
and the treatment is actually tonic in its nature. 

7. The result is satisfactory, physiological and permanent 

Suppression of Menses.~On March 1 1 of this year Miss B 
B., aged 20, consulted me at my office. Her menses had ceasec 
suddenly two years before and had not returned, but she ha( 
had instead, about once a month, a slight, thin, leucorrhoea 
discharge, preceded by such feelings as she had previousl; 
experienced at time of natural menstruation. She was emaci 
ated, weak and anaemic, but had no evidence of lung disease 

She had been treated by two gynecolgists who had dilate( 
the uterine cervix and had given her emmenagogues am 
tonics. Upon examination I found such stenosis of th 
cervical canal that it was with extreme difficulty that I passe( 
the smallest uterine sound. The uterus was normal as t^ 
length and position. I was unable to pass the smallest elec 



TREATMENT OE THE LEStONS OF THE CERVIX. 39 1 

trical sound, so again passed the uterine sound through the 
canal and connected it with the negative cord, and placed the 
positive electrode in the patient's hands, and turned on a cur- 
rent of 15 mil., and a bloody froth of hydrogen gas mixed 
with a little blood oozed out as usual from the Os. 

I moved the sound backward and forward constantly during 
the stance of ten minutes and at the close it passed easily. 
The current was turned on and off slowly, and the patient felt 
no shock but experienced a slight burning sensation at her 
hands and some slight abdominal pain, at the close of the 
stance complained of backache. 

It was nearly time for her monthly leucorrhoeal period. A 
week later she called and informed me that two days after 
the treatment her courses came or freely and naturally and 
that she felt much better. Three days prior to her April 
period I gave her another electrical treatment like the first, 
except that I used a larger sound, and except that the current 
used was much weaker, only 8 mil. eight minutes. A week 
later she called again and said her menses came on time and 
quite naturally. The stenosis of the canal had evidently 
been permanently relieved ; she had some color ; had gained 
in weight ; was stronger ^nd felt quite well. She has since 
remained well. {Woolsey^ 

To Soften the Indurated Angle of a Sharp Uterine 
Flexion. — Galvanic. — For the purpose of establishing drainage 
or inserting an electrode to the fundus for intra-uterine treat- 
ment it is sometimes necessary to remove a barrier to free 
entrance to the canal. 

This is often accomplished with the aid of the softening 
and absorbing action of the negative galvanic current. The 
technique of the method is exactly the same as that for 
stenosis of the Os described above. The dosage, however, will 
often require increase. 

If unable to pass the electrode fully into the uterus at either 
the first or second sitting with an amperage of about ten mil., 
continued for eight minutes, a more active electrolytic soften- 
ing will be secured by increasing- the current for a brief 
interval up to 20 or 25 mil., if tolerance permits. Little or no 
pressure should be exerted upon the electrode as the action 
of the current carries it into the uterus almost as if by suction 



392 TREATMENT OF THE LESIONS OF THE CERVIX. 

when sufficient softening has taken place. The desired result 
is very speedily obtained in average cases, but it is the rule to 
persevere until the electrode enters the canal. This procedure 
is as safe and simple as it is clinically valuable. It will often 
aid the introduction of an electrode into tortuous canals, 
although there will be met some cases that cannot be entered 
by any manipulation. Unless such women have grave disease, 
however, they improve under electrical treatment and often 
obtain as complete a symptomatic cure as if the canal was 
open to the fundus. 



CHAPTER XXIIl. 

TREATMENT OF OVARIAN LESIONS AND OTHER PELVIC 
DERANGEMENTS. 

Congested and prolapsed ovary. Ovaritis. Reflex pain in the breasts. Pelvic 
pains. Obscure uterine derangements. Ovarian neuralgias. Pelvic pain 
dependent upon disordered innervation. Ovarian irritation and menstrual 
irregularity in young women without evidence of local disease. Post-opera- 
tive pelvic pain. Post-operative electrical treatment. 

Congested and Prolapsed Ovary.— When the ovary is 
enlarged, heavy and extremely sensitive to the slightest pres- 
sure and drags below its proper level, the temporary aggrava- 
tion may be at once relieved by bipolar faradic sedation. 

Connect the tip of the vaginal bipolar electrode with the 
positive pole of the improved high-tension induction coil 




Fig. 133. Bipolar electrode. 

apparatus and the inner half of the electrode to the nega- 
tive pole. Warm and lubricate the surface, with a little 
plain vaseline and insert it deeply into the cavity so that 
the tip is directed against the point of greatest tenderness. 
Retain it with gentle pressure in this position. 

Switch 1,500 yards of No. 36 wire coil, the finely adjusted 
rapid vibrator and four cells into circuit. Start the .current 
into action and increase it from zero through the secondary 
rheostat until it is perceptibly felt by the patient. Cautiously 
and gradually increase the current for at least ten minutes, 

393 



394 OVARIAN AND OTHER PELVIC LESIONS. 

following up every abatement of tenderness with an increase 
in E. M. F. 

After about ten minutes maintain the current evenly at the 
maximum dose for five minutes more, during which time it 
will become less and less perceptible as sedation is established. 
Gradually reduce the current to zero after a total sitting of 
twenty minutes. Insert a carbolic and glycerin tampon to 
support the ovary after withdrawing the electrode. If the 
condition is merely an acute aggravation a few daily treat- 
ments of this kind will be sufficient. 

If it is a more chronic case the immediate relief will be 
prompt and effective, but to establish improvement, reduce the 
enlargement and tone up the supports will require more. per- 
sistent a:pplications, but the method is the same. 

Ovaritis. — Whether this condition is acute or chronic, 
whether the ovary is simply congested or is enlarged, sensitive 
and prolapsed, causing severe dysmenorrhoea, an efficient 
treatment is often bipolar faradic sedation. 

Faradic. — Warm and lubricate the bipolar electrode with plain 
vaseline, connect the tip invariably with the positive pole of the 




Fig. 1 34. Bipolar vaginal electrode, 
high-tension induction coil apparatus, connect the inner half with 
the negative pole and insert it deeply into the vaginal cul-de-sac. 

Switch the 1,500 yard No. 36 wire coil, the rapid vibrator and 
four cells into circuit, and with the current strength regulated 
through the rheostat to the point of agreeable comfort hold 
the tip of the electrode successively against each point of ex- 
treme tenderness detected by shifting the electrode very care- 
fully from side to side. 

Maintain the action of the current until absolute sedation 
is obtained and the patient is left without the slightest pain. 
Reduce the current to zero before withdrawing the electrode 



OVARIAN AND OTHER PELVIC LESIONS. 395 

and close the sitting by inserting a carbolic and glycerine tam- 
pon if it can be tolerated. 

Repeat bipolar sedation for twenty minutes daily until the 
relief of pain lasts more than one day. Then repeat every 
second day and proceed from the No. 36 coil to No. 32 coil 
with increased current strength as rapidly as improvement 
creates a healthy toleration. 

After full sedation is secured supplement bipolar faradiza- 
tion with the positive galvanic current, if the individual case 
required its aid. 

Galvanic. — Place a felt-covered, flat electrode, 6X9, saturated 
with the usual warm solution of bicarbonate of soda, upon the 
lower abdomen over the ovary and connect it with the negative 




Fig. 135. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

pole of the galvanic switchboard. Connect with the positive 
pole the carbon ball electrode and wrap it with as large a mass 




Fig. 136. Carbon ball electrode. 

of absorbent cotton as will comfortably enter the cavity. 
Moisten it in the warm bicarbonate of soda solution and do 
not press the cotton any drier than is needed to avoid dripping. 



396 



OVARIAN AND OTHER PELVIC LESIONS. 



The more moisture it contains the better. Either, with or 
without a speculum insert the bail electrode into the yagina 
and support it gently against the inflamed ovary. 

Increase the constant galvanic current from zero up to 15 or 
20 mil. at the first sitting. Maintain for about ten minutes 
and reduce gradually to zero. At later sittings the amperage 
may be increased gradually to 30 and 40 mil., as improvement 
advances, and the increase in the tolerance of the tissues is the 
measure of the benefit derived. After withdrawing the elec- 
trode insert a carbolic and glycerin tampon. 

Repeat applications three times a week between menstrual 
periods. 

If the case is an old one with adhesions and cold deposits the 
use of the negative galvanic current to soften and promote re- 
absorption should be combined with yigorous bipolar faradi- 
zation. In these cases the positive current is not indicated. 
The management of technique is, however, precisely the same 
and employs the same electrodes. 

Another useful method is the Hydr -electric Douche as 
described below : 




Fig. 137. Fine felt or sponge-covered electrode— assorted sizes with soft rubber 

insulating backs. 



Galvanic Douche. — Moisten a felt-covered electrode, 7 X 10, 
in a one per cent, hot water bicarbonate of soda solution and 
apply it upon the abdomen with the patient in the dorsal posi- 



OVARIAN AND OTHER PELVIC LESIONS. 397 

tion on the operating table. Connect this with the positive 
galvanic pole. 

Prepare about three quarts of any preferred alkaline or anti- 
septic solution in the irrigating jar placed at a sufficient height 
to administer an ordinary vaginal douche. Attach the end of 
the rubber tube to the vaginal electrode and connect the elec- 
trode to the negative galvanic pole. Have the water hot. 
When the electrode is inserted turn the stop-cock of the rubber 
tube and allow a continuous flow of the solution. Immediately 
increase the constant galvanic current fron zero up to 15 or 20 
mil., and maintain the current until the irrigator is empty, or 
for fifteen or more minutes. Prescribe other measures indi- 
cated in each individual case, repeat the electrical application 
daily for a few days and three times a week until recovered. 

Inflamed and Prolapsed Ovaries. — The principle of treat 
ing any grade of this condition from the acute stage to almost 
any state short of malignant degeneration follows the now 
familiar rules of applying faradic and galvanic currents to re- 
lieve pain, restore healthy nutrition and tonicity to muscular 
fibres. 

The remedy of first importance is vaginal bipolar faradic 




Fig. 13S. Bipolar vaginal electrode. 

sedation followed by a glycerine tampon when this can be com- 
fortably employed. Repeat daily until sensitiveness to pres- 
sure has been subdued, then alternate the use of the galvanic 
current with the positive pole applied in the usual manner with 
the cotton-wrapped carbon ball electrode against the ovary. 

■place the felt-covered negative electrode, about 6X9, under 
the sacrum or over the hypogastrium. Gradually increase the 
constant galvanic current from zero until it produces a. mild 



398 OVARIAN AND OTHER PELVIC LESIONS. 

sensation to the patient or not over 20 mil. at the first sitting. 
After about eight or ten minutes reduce to zero and follow 
with the bipolar faradic sedation. Repeat three times a 
week. 




Fig. 139. Carbon vaginal electrode witii removable carbon tip. 

The subsequent increase of the current strength will follow 
the usual course up to 40 or 50 mil. 

When structural changes have occurred, the prognosis is af- 
fected rather than the method of treatment, the differences in 
the latter consisting chiefly in selecting the pole (either posi- 
tive or negative) which conforms to the indications present. 
In one way or another almost all these cases, even those which 
have been sent by thousands to the operating table can be 
either entirely cured or given symptomatic relief by the per- 
sistent use of conservative electrical methods, and the number 
who will find no relief except by the removal of the diseased 
organs is so small that the physician in ordinary practice can- 
not compute the vanishing percentage. 

In all cases regardless of theory the first indication is a trial 
of proper electrical methods. Not until long after other meas- 
ures have failed should the uncertainties and risks of a radical 
operation be considered, and when an operation is regarded as 
necessary it is well to take into account that surgery also scores 
many failures to restore comfort to patients. 

In the treatment of cases of this kind I place electricity first 
and other remedial measures after. It goes without saying 
that a displaced ovary, the same as any other displaced organ, 
must be held in position and made to stay at home. In these 
cases that I have reported when the ovary was prolapsed it 
was held in position by a wool tampon, and during the inter* 



OVARIAN AND OTHER PELVIC LESIONS. 399 

vals of the application of the galvanism it was still kept up. 
The surroundings and habits of the patient must not be lost 
sight of. Dancing, horseback riding, bicycle riding and pedes- 
trian feats, which young ladies who go into the country are so 
fond of taking and boasting of, must be forbidden. {Brown) 

Reflex Pain in the Breasts.— The infra-mammary pains 
which uterine cases often complain of do not need a local ap- 
plication of an electric current, but generally disappear early in 
the course of the pelvic treatment. The aching tenderness which 
sometimes pervades the entire breasts of women whose uterus 
becomes congested and heavy is promptly relieved by vigorous 
vaginal bipolar faradization followed by a glycerine tampon. 
In chronic cases in which relapses occur from time to time 
a return for an occasional application suffices to maintain an 
average degree of comfort. 

Pelvic Pains. — In the four chief methods of employing elec- 
tricity in the treatment of pelvic conditions we possess the 
means of almost certainly relieving or curing any form of pain 
which is not associated with a condition which imperatively 
demands an operation, and these are very few. The failure of 
properly employed galvanic and high-tension induction coil 
currents according to the directions given in this book may 
therefore cause the operator to suspect a condition which is 
not amenable to conservative treatment. 

In any case in which pain is a symptom the indications for 
proper electrical treatment will usually appear at sight upon 
making the ordinary examination. The appearance of the 
tissues adds very much to what may be learned from a digital 
examination and history, and explicit directions are so fully 
given in these chapters that the reader may turn from his 
diagnosis to the index of this book and almost certainly select 
at once the proper course to pursue. 

It is important to acquire a knowledge of the order in which 
to attack parts of a complicated condition. Relieve the more 
acute states first, or those which operate as causes, and later 
dispose of the remaining lesions or symptoms. 



400 OVARIAN AND OTHER PELVIC LESIONS. 

Obscure Uterine Derangements. — For the comfort of the 
general practitioner who is gratified to be able to please his 
patient with a satisfactory cure even without a classical diag- 
nosis it may be confidently stated that electricity offers valu- 
able assistance in this way. 

When reflex symptoms or symptoms referred directly to the 
pelvis point to some uterine cause which examination fails to 
detect, the physician may clear up the matter by a few treat- 
ments of percutaneous galvanism or bipolar faradization. If 
one or the other of these methods abates the symptom it should 
be continued until it completes its work. Attention to an- 
?emia and the general health of the patient will reinforce the 
local application. 

The symptomatic relief thus often secured to temporary suf- 
ferers through the aid of medical electricity is one of several 
potential arguments for its more general use. 

Ovarian Neuralgias.— Over these pains of women electric 
currents exercise a sovereign and beneficent sway. 

Faradic.—'^ divm and lubricate the improved bipolar vaginal 




Fig. 140. Bipolar vaginal electrode. 

electrode "and insert it into the cavity so that the positive tip 
rests upon the site of the greatest tenderness. Support it with 
very gentle pressure during treatment. Pursue the method of 
bipolar faradic sedation, as fully described under that heading. 
(See Index.) 

Repeat the application daily for a few days and when relief 
extends to longer intervals lengthen the time between the 
sittings accordingly. If relief becomes satisfactory and pro- 
gressive continue the sittings three times a week until com- 
plete health is restored. 



OVARIAN AND OTHER PELVIC LESIONS. 40I 

As the diagnosis of the cause of pain cannot always be made 
with certainty we may suspect some graver lesion of the ovary 
if improvement is not satisfactory and is not retarded by the 
patient's carelessness or by known complications. 

In any event vaginal bipolar faradic sedation is the first rem- 
edy to employ for the relief of pain and the improvement of 
local nutrition. S/ances three times a week between menstrual 
periods will in a short time give relief to an uncomplicated case. 
If the ovary is hypersemic and drags heavily upon its supports 
the same method will give tone to the tissues, disperse the 
congestive engorgement and with the aid of a carbolic and 
glycerin tampon after the withdrawal of the electrode the 
patient will rapidly secure permanent comfort. 

Galvanic. — If some occasional pain returns after a reason- 




Fig. 141. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

able number of bipolar treatments place a felt-covered, flat 
electrode, 6X9, over the lower abdomen on the side affected 
and connect it with the negative pole of the galvanic switch- 
board. 

Connect a cotton-wrapped, carbon ball electrode with the 
positive pole, moisten it in the invariable warm water solution 
of bicarbonate of soda and insert it in the vagina in contact 
with the sensitive organ. 

Gradually increase the constant galvanic current from zero 
26 



402 



OVARIAN AND OTHER PELVIC LESIONS. 



up to about 20 mil., maintain this dosage for ten minutes 
and reduce to zero. Repeat three times a week. By the use 
of one or both of these methods many of the painful ovarian 




Fig. 142. Carbon vaginal electrode with removable' carbon tip. 

disturbances may be treated with perfect confidence in the 
result. Unless a grave lesion is present to prevent its curative 
action there is nothing so practical and satisfactory in the 
whole range of medical gynecology as the action of high effi- 
ciency electrical currents in the treatment of neuroses and 
functional disturbances of the pelvic organs. 

Pelvic Pain dependent upon Disordered Innervation, — 
In all neuralgias of the pelvis, whatever may be their nature 
or severity, the element of pain can almost infallibly be com- 
batted by vaginal bipolar faradic sedation or by percutaneous 
galvanism. 

Faradic. — Attach the positive pole of the high-tension in- 
duction coil apparatus to the tip of the electrode. Always 



GALVANO FARADIC MFG. CO.NY,» 



-'^K 



Fig. 143. A proper bipolar electrode. 

make the other pole negative. Warm and lubricate the 
electrode with plain vaseline and insert it into the vagina as 
deeply as it will go. It may either be held, in position by 
the operator or an assistant or by the patient herself by means 
of the author's bipolar electrode holder. 

Select first the 1,500 yard No. 36 coil, the rapid vibrator and 



OVARIAN AND OTHER PELVIC LESIONS. 403 

four cells. After the electrode is in position start the current 
into action and increase it from zero by means of the rheostat 
until it is felt by the patient. Direct the tip of the electrode 
gently against each point of local tenderness that can be found 
and hold it steadily in place until the current, now carefully 
increased to full tolerance, dies apparently away under the 
sedative action. After complete sedation of all points of 
tenderness is effected reduce the current gradually to zero and 
withdraw the electrode. 

Take plenty of time, twenty minutes or even longer if nec- 
essary, to produce complete sedation at the first sitting. As 
soon as improvement advances so that the 36 coil is no longer 
strongly felt switch the 800 yard No. 32 coil into circuit and 
continue the same method until normal painlessness is re- 
stored. 

Sittings may be repeated daily for the first week and after- 
wards three times a week between menstrual periods. 

Improvement is usually so rapid and satisfactory that if 
good results are not speedily obtained some graver cause of 
the pain must be suspected, sought, found and subjected to 
appropriate treatment. 

Never let a bipolar electrode slip out of the cavity and come 
in contact with the vulvar tissues while any form of induction 
coil current is passing. The shock to the patient would be a 
lesson never to be forgotten, and should be avoided by simple 
care. 

Galvanic. — Place the positive felt^covered electrode over the 
ovary and the negative under the sacrum. Pass a constant 
galvanic current of about 20 mil. at first, gradually increased 
to 30 or 40 mil. Duration of sitting 15 minutes, three times 
a week. It is well often to alternate the bipolar and galvanic 
methods. 

Ovarian Irritation and Biienstrual Irregularity in Young 
Women without Evidence of Local Disease.— Vaginal bipolar 
faradization will control the irritability, tranquillize the general 
nervous system, promote a healthy state of the tissues, and do 



404 OVARIAN AND OTHER PELVIC LESIONS. ■ 

these cases more good than any other single remedy in thera- 
peutics. It should be regulated to the dose of agreeable toler- 
ance and repeated daily for the first week. After improvement 
is progressing repeat three times a week between periods for 
two or three months. 

For the proper selection of current strength and management 
of the technique see section describing bipolar faradization. 

The percutaneous galvanic method is also a valuable rem- 
edy. 

Post-Operative Pelvic Pains.— When these can be attrib- 
uted to a traumatic neuritis, or neuralgia, or pelvic congestion, 
or exudation, the immediate and persistent use of vaginal bi- 
polar faradic sedation should be added to any other measures 
for relief. It is peculiarly suited to cases of this kind. 

The hydro-electric rectal douche application also presents 
special advantages when the action of the bowels remains ar- 
rested after a laparotomy* The technique of this administra- 
tion is fully described under other headings. 

The ' remarkable power possessed by the high-tension in- 
duction coil current to relieve and even remove neuralgic pain 
has been doubted by many (who have never tested high efifi- 
ciency apparatus) but to me there is nothing more certain. I 
recall at this moment many cases of pain in the pelvis con- 
tinuing long after the operation for the removal of the ovaries 
which the operation had failed to cure, and which was more or 
less promptly cured by prolonged application of the rapidly 
interrupted coil current to the inside of, or to the neighborhood 
of the uterus with the bipolar intra-uterine or vaginal elec- 
trode. In like manner I have entirely cured without operation 
the neuralgic pains of other patients for whom abdominal 
section had been advised by my colleagues and even formerly 
by myself. Certain it is, however, that only very rapid inter- 
ruptions possess this anaesthetic effect. {Smithy 

When we consider the immense force of pain as an argu- 
ment to induce patients to submit to operations for its relief 
and the marked influence of galvanic currents, high-tension 
induction coil currents and static electricity, over so many 
pains of obscure origin, it must be regarded as little short of 



OVARIAN AND OTHER PELVIC LESIONS. 405 

malpractice to operate without other reason. The atmosphere 
surrounding the surgeon in his hospital and clinical work is 
partly made up of fictitious confidence in the beneficial result 
he produces and actual ignorance of the benefits which are 
readily obtained by conservative methods. 

The after-histories of thousands of patients who figure as 
recovered in surgical tables are far more familiar to the family 
physician into whose hands they come for succeeding treat- 
ment than to the specialist and operator out of whose hands 
they usually pass in a few weeks ; often glad to escape with 
their lives and concealing ailments in order to escape. 

With the gradual introduction of improved electrical ap- 
paratus into the offices of an increasing number of practi- 
tioners there is a gradual decrease in the number of patients 
who must be urged to seek that last resort of desperate cases, 
the operating table. 

Post-Operative Electrical Treatment.— In an interesting 
case reported by Dr. Flinn the patient presented a great variety 
of distressing symptoms which remained unrelieved after six 
months of medical treatment, eight months of electrical treat- 
ment repeated twice a week, and a surgical operation. 

When the laparotomy was performed, the left ovary was 
normal, but there was found a fibroid cyst of the right ovary 
the size of a small Brazil nut. The ovary and several small 
cysts in the same region were removed. Adhesion of the 
uterus was broken up, ventral fixation done, and a stricture of 
the rectum was dilated. 

Following the operation there was no improvement in the 
dysmenorrhoea, the right limb was nearly useless, appetite 
poor, bowels constipated, the severe pains within the abdomen 
remained and she had no sleep without drugs. There was no 
special improvement resulting from the operation. Electrical 
treatment was again resumed and this time with a general 
amelioration of all the .symptoms which in a month and a half 
became so marked as to warrant an entirely favorable prognosis. 

Others have reported similar cases and have had the expe- 
rience of treating patients after operations and having them im- 



4o6 OVARIAN AND OTHER PELVIC LESIONS. 

prove. It is not uncommon to treat cases apparently without 
benefit, have them fail to receive benefit from an operation, 
and finally have them treated again with electricity with most 
decided improvement. In many of these cases the explanation 
of the apparent anomaly is simple, for after the exciting cause 
has been removed by the operation and nature has not corrected 
the remaining functional derangement, electricity takes the 
patient in hand, increases the nutrition, relieves the pain, 
stimulates the nerve supply, and produces the desired sympto- 
matic cure. These results illustrate the inter-dependence and 
friendly relation of electric currents and the surgeon's knife. 
The utility of electro-therapeutics as an adjunct to the work of 
the pelvic surgeon cannot be too thoroughly appreciated by 
all who look singly to the patient's welfare, for at the point at 
which cutting and suturing stops, and leaves the rest to nature, 
the tonic and nutritional action of electricity steps in and, in 
the suggestive words of Cavallo written more than one hundred 
years ago, " aids the innate endeavor of nature to restore the 
sound stated 



CHAPTER XXIV. 

TREATMENT OF PELVIC INFLAMMATION, 

Pelvic peritonitis in acute stage. Clinical cases. Chronic peri-metritis and in- 
flammatory exudations. Clinical remarks. Acute catarrhal endo-salpingitis ; 
subacute ; chronic. The treatment of catarrhal salpingitis. The treatment 
of suppurative salpingitis. Abscess of fallopian tube. Remarlis upon sup- 
purative peri-uterine inflammations. Pelvic haematoma and h2emotocele. 

Pelvic Peritonitis in Acute Stage. — The damage done 
to a woman's health by peri-uterine inflammations may render 
her a lifelong sufferer, hence the importance of effective treat- 
ment to allay inflammation and prevent the formation of pus 
is very great. According to Sexton : " The first indication is 
to relieve pain, and in most instances this can best be done by 
the early administration of saline purgatives. Epsom salts in 
saturated solution is the first and quickest method. It empties 
the bowels, abstracts moisture from the tissues, drains the 
engorged pelvic vessels and diminishes the blood supply to 
the inflamed parts. Glycerine into the rectum next supple- 
ments the relief of pain by similar osmosis. When medical 
treatment has reduced the local pain and tenderness we can 
apply loose tampons of glycerine over the-irregular masses that 
can be felt under the fingers." 

When, however, the local tenderness will not permit a 
finger to be inserted for an examination, and in the onset of 
the attack, at the very first call of the physician, as soon as he 
has prescribed any measures whatever, a warm and lubricated 
vaginal bipolar electrode may be gently passed into the vagina 
and supported so that no sense of weight is felt by the patient. 

From the moment the carefully regulated soothing current 

pours into the parts the arrest of pain and the inflammatory 

407 ■ 



408 TREATMENT OF PELVIC INFLAMMATION. 

process begins, and if the application is early enough, resolution 
without suppuration is almost assured. In a manual upon 
gynecology to which I have elsewhere referred, and which rec- 
ommends mild faradization for acute inflammations within 
the pelvis, it is stated that " the most convenient faradic battery 
to employ is one in which the primary current is generated by 
single dry cell " ! ! 

In endeavoring to obtain clinical results in acute inflamma- 
tions, all such inferior apparatus, whether cheap or costly, must 
be abandoned. To employ such a battery as quoted above is 
positive malpractice. The high-tension induction coil current 
is a sine gua non, and I know of but one pattern of bipolar 
electrode that is proper to use. So accustomed are physicians 
to regard their faradic batteries from the single standpoint of 
price that unless the practitioner has got beyond this rudi- 
mentary point in his training in electro-therapeutics and can 
distinguish between the finer shadings and qualities of dif- 
ferent rapid vibrators and different coils he cannot safely em- 
ploy the sovereign remedy urgently demanded in the acute stage 
of pelvic inflammation. Magnificent as are the results to the 
patient produced by true bipolar sedation the calamities of 
disease alone have fresh horrors added to them at the mere 
thought of treatment by the family faradic battery. 

In common with other physicians who still remain strangers 
to the finer therapeutics of high-tension coils Sexton fails to 
mention the sheet anchor of treatment in acute pelvic inflam- 
mation but proceeds : " After the tenderness has grown less 
and after a few days have elapsed the negative galvanic current 
may be applied, not over 20 mil. repeated every second day. 
The effect upon the pain, of this application, is not infrequently 
simply wonderful. The swelling diminishes ; under its influence 
I have certainly seen lumps, masses, — hard tender masses — in 
the broad ligaments disappear, the uterus become movable 
and the hardness of the vaginal vault disappear." 

In hastening resolution, in quickly reducing the inflammatory 
tenderness and preparing the patient for the second (galvanic) 



TREATMENT OF PELVIC INFLAMMATION. 4O9 

stage of treatment which deals with the removal and reabsorp- 
tion of exudates we have no other remedy like bipolar faradic 
sedation. 

Take to the bedside the portable high-tension induction coil 
apparatus, a pair of conducting cords and bipolar electrode. 




Fig. 144. Bipolar vaginal electrode. 

Connect the cord from the positive pole to the tip of the 
electrode and the negative pole to the inner half. Warm the 
electrode to blood heat, lubricate it with a little plain vaseline 
and with scarcely any disturbance to the patient it can be in- 
serted to the posterior cul de sac of the vagina by the phy- 
sician, or attendant nurse, or by the patient herself. 

No speculum is employed and no preparation or douche of 
any kind is necessary. The patient remains recumbent on her 
back, the electrode is carried under the coverings, inserted into 
position and retained there in the simplest possible manner. 

During the first application an attendant should hold the 
thumb against the external end of the electrode to guard it 
from slipping out, but as soon as the patient becomes composed 
she can keep it in position without further Tielp by the pressure 
of her own limbs. 

There is neither hurt nor shock of any kind to the application. 
Switch four cells, the rapid vibrator and 2,000 yards of fine 
coil into the circuit with the current at zero and controlled 
through the secondary rheostat. With the vibrator in smooth 
and even action gradually increase the current strength until 
the patient perceives a sense of comfortable grasp upon the 
tissues. After five minutes enough sedation will be accom- 
plished to lessen the tenderness so that the current strength 
becomes less perceptible. Increase it slightly again up to the 



410 TREATMENT OF PELVIC INFLAMMATION. 

point of agreeajble tolerance and maintain it evenly until sen- 
sation again diminishes. 

If the current from 2,ooo yards of fine coil ceases to be 
sufificient with an E. M. F. of four cells it is not wise to switch 
the fifth or sixth cell of the apparatus into circuit as the in- 
tense deflagration of the spark between the platinum tip and 
the surface of the spring vibrator is needlessly destructive. 
Instead of attempting to increase the E. M. F. it is better to 
reduce the length of coil, and by adding resistance through the 
secondary rheostat we are able to switch from one coil to an- 
other without startling the patient or reducing the current to 
zero. 1,500 yards of No. 36 coil with an E. M. F. of four cells 
will usually deal with the acute inflammatory stage of extreme 
tenderness. 

Continue the application with a gradual regulation of the 
current strength up to the point of coinplete relief of all pain, 
and when this state of sedation is achieved do not abruptly 
stop the current but continue fully fifteen minutes longer. 
The process of closing the seance must be gradual. Reduce 
the current a very little at a time until it is scarcely perceptible, 
and after maintaining at this point until it is not felt at all re- 
duce the current to zero through the rheostat so slowly as to 
consume a couple of minutes. Finally switch the cells out of 
circuit and withdraw the electrode. 

The entire application may require thirty minutes or an 
hour, and the relief afforded will be temporary at first but will 
become more and more permanent in proportion to the arrest of 
the inflammation. The return of pain in a few hours is a signal 
to renew the application, which may be again repeated in the 
same manner. The duration of the application is governed 
by the effect, and while it must be long enough to produce the 
effect the length of time required will diminish after the first 
few applications. 

Four treatments may be needed during the first twenty-four 
hours, and this frequency is reduced as the pain disappears and 
the inflammation subsides until the acute symptoms are con- 



TREAT.MEXT OF PELVIC INFLAMMATION. 



411 



trolled by one application per day. When retrogression is 
established and only the effects of the inflammation require 
treatment there will be far less need for an electrolytic current 
than when bipolar sedation is not used. When it is required 
the technique is as follows : 

Vaginal Galvanic Application. — Saturate a felt-covered, flat 
electrode, 7 X 10, in the usual hot-water solution of soda bicar- 




Fig. 145. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

bonate and apply it to the abdomen. For the first application 
connect it with the negative pole. Wrap as large a pledget 
of absorbent cotton around the vaginal carbon ball electrode 




Fig. 146. Carbon ball electrode. 



as can be inserted into the cavity without distress to the 
patient. Moisten it in the hot bicarbonate of soda solution, 
connect it with the positive galvanic terminal, and either with 
or without a speculum insert it as deeply into the posterior 
cul-de-sac as it will go. Support the handle so that it is re- 
tained comfortably in position throughout the application. 

Gradually increase the constant galvanic current through 
the rheostat from zero up to about 1 5 or 20 mil., or only sufifi- 



412 TREATMENT OF PELVIC INFLAMMATION. 

cient to gradually produce a perceptible sensation of increas- 
ing comfort, during the seance. 

After about fifteen minutes reduce the current gradually to 
zero and withdraw the electrode. If a small amount of toler- 
ance to the current and great tenderness and irritability indicate 
still further use of the positive polarity the same application 
may be repeated for several days before attempting to hasten 
absorption with the negative current. 

As soon as the acute symptoms have sufficiently subsided to 
indicate the use of the negative pole the galvanic application 
requires no other change than making the intra-vaginal elec- 
trode negative and increasing the amperage of the current as 
increasing tolerance develops. At the close of each sitting a 
carbolic and glycerin tampon may be inserted. 

Under treatment of this character pelvic peritonitis is 
brought under control, and after acute symptoms have subsided 
the recent exudates are rapidly removed, in some cases quite 
completely and in others sufficiently to produce complete 
symptomatic relief. In grave septic cases the above measures 
are useless. 

Case I. Mrs. C , age 25 ; was called on account of 

severe pain and vomiting ; found great depression, temperature 
103 degrees, severe pelvic pain, had been vomiting for several 
hours. Suspecting the cause to be pelvic, made examination 
under an anaesthetic, as the patient could not be touched, so 
great was the pain and tenderness. The left ovary could not 
be mapped out on account of a large mass of exudation filling 
that side of the pelvis, and crowding the uterus well over to 
the right side. There was evidence of an old endometritis, 
and the conclusion was that we had a case of parametritis of 
probable septic origin, and that the pain and vomiting was 
caused by pressure upon the ovary from the adhesions and 
exudation. A bipolar electrode (modified from the well-known 
Apostoli electrode), with bifurcated cord, and connected with 
positive pole of a high-tension Faradic battery, was introduced 
per vaginam, and a suitable pad, 6 by 6 inches, placed over the 
solar plexus, and with single cord attached to the negative 
pole. It may be well to state in this connection that the 
secondary coil used was composed of 1,541 yards of No. 36 
wire, that the primary was excited by six cells controlled by a 



TREATMENT OF PELVIC INFLAMMATION. 413 

rheostat in the battery circuit, and the vibrator was capable 
of very fine adjustment and very rapid vibrations. A stance 
of twenty minutes was given, affording great relief from pain 
and entire cessation of vomiting, and lowering the temperature 
to lOi degrees. The applications were repeated every two to 
six hours, as indicated, for two days, resulting in such amelio- 
ration of all the symptoms that the patient became entirely 
comfortable and free from pain except when an effort was 
made to move about. Temperature normal ; no vomiting. 
Applications were continued twice daily for ten days, when 
galvanism was erriployed to remove the exudation by electro- 
lysis. ■ It is only fair to say, however, that the Faradic current 
was continued daily, and no doubt contributed materially to 
the ultimate removal of all the adhesions and exudation, 
restoring to health a case which ordinarily would be considered 
a subject for a hysterectomy, as soon as the patient could be 
got in a condition for operation. 

Case 2. Miss R -, age 40; applied for relief from severe 

pain in left iliac region ; temperature 102 degrees ; gave history 
of soreness and inclination to stoop with pain when an attempt 
was made to stand erect. For twelve hours previous to being 
seen (June 4, 1895), pain had been severe, which was only 
partially relieved by % grain morphia. Examination per 
vaginam showed great tenderness — could not allow any pres- 
sure ■ over left iliac region. The left fallopian tube was en- 
larged and very painful, a hard exudation filling Douglass 
cul-de-sac, and also above the bladder, the latter causing great 
pain when the urine was voided. The diagnosis was pyosal- 
pinx, with para-uterine inflammation. Bipolar faradization 
was given for thirty minutes, with great relief from pain and 
reduction of temperature to 99 2-10 degrees. The patient 
slept two hours, and upon awakening complained of only a 
partial return of pain ; temperature 100 degrees. The appli- 
cation was repeated, and again followed by relief of pain and 
lowering of temperature to 99 degrees, and a longer period of 
comparative comfort. Treatment continued every four hours 
for two days. By this time active inflammation had subsided, 
and negative electrolysis was employed to evacuate the tube 
into the uterus.- This measure proved successful, the patient 
reporting next day a discharge of two or three ounces of thin 
pus per vaginam, and an examination proved that the tube 
had been evacuated. 

The faradization was continued every other day, which with 
appropriate galvanism disposed of the exudation and adhe- 
sions. Curetting was advised, with the view of disposing of 
the endometritis, facilitating drainage of the tube to prevent a 
recurrence. This the patient has so far declined to do. 



414 TREATMENT OF PELVIC INFLAMMATION. 

Case 3. Mrs. N , aged 24. When first seen patient com- 
plained of severe pain in the head and back ; pulse 120; tern- 
perature 104 degrees. Gave history of dysmenorrhcea, and as 
her menstrual period was then due, it was apparent that the 
cause of her suffering was due to extreme congestion. Hot 
vaginal douches were ordered, and pot. bromide, followed by 
morphia. After four hours with no relief, bipolar faradiza- 
tion was resorted to, with considerable diminution of the 
pain ; repeated in two hours, with the effect of bringing on 
the menstrual flow and complete subsidence of pain, abnormal 
temperature and nervous distress. The usual period of these 
applications is fifteen minutes, governed, however, by circum- 
stances, of which the attendant must be the judge in each 
particular case. 

Points for consideration afe the pathological conditions 
present : what is desired to be accomplished, frequency of ap- 
plications and a thorough conception of the power and limita- 
tions of the apparatus used. It is a great mistake for any one 
to expect uniform favorable results from the use of coil cur- 
rents, or in fact any form of electricity, till the principles of . 
electro-physics are well understood, and for gynecological work 
the special training and experience which must constitute the 
equipment of a successful specialist should always include the 
other necessary attributes of a good physician. {Phelps) 

Chronic Peri- and Para-Metritis, and Inflammatory Exuda- 
tions within the Pelvis after Primary Acute Inflammation 
has Subsided.^ — The electro-therapeutics of pelvic inflamma- 
tions may properly be regarded as (i) preventive in the acute 
stage preceding exudation ; (2) curative and reparative in the 
recent stage of exudation and (3) pallative when the damage 
is chronic and complicated. 

Acute congestion and inflammation is to be combatted in all 
cases by vaginal bipolar faradic sedation, applied with gentle- 
ness, maintained for long seances, and repeated as often as 
needed for the relief of the patient, as previously directed in 
the treatment of pelvic peritonitis. It is absolutely impossible 
to oversoothe an inflamed tissue, and if the induction coil 
apparatus and electrode are of the proper type and the cor- 
rect dose is directed with discretion there is not only no harm 
to fear in thus attacking the most violent inflammation but 
there is a positive certainty of benefit. 



TREATMENT OF PELVIC INFLAMMATION. 41 5 

This method does not in any way interfere with other 
medical prescribing, but it co-operates efficiently with the 
best methods of other treatment and practically assures a 
favorable termination in the case. It is the first step to the 
treatment of every case whether acute or chronic to prepare 
the way for the second step. 

During the early treatment of pelvic exudates, before a 
carbon ball electrode is tolerated, an excellent method of 
applying the galvanic current is as follows : 

Moisten a felt-covered, flat electrode, 7 X 10, in a one per 
cent, hot-water bicarbonate of soda solution and apply it upon 
the abdomen with the patient in the dorsal position on the 
operating table. Connect this with the positive galvanic 
pole. 

Prepare about three quarts of any preferred alkaline and 
antiseptic solution in an irrigating jar placed at a sufficient 
height to administer an ordinary vaginal douche. 




Fig. 147. Electrode for vaginal hydro-electric applications. 

Attach the end of the rubber tube to the vaginal electrode 
and connect the electrode to the negative galvanic pole. Have 
the water hot. When the electrode is inserted turn the stop- 
cock of the rubber tube and allow a continuous flow of the 
solution. Immediately increase the constant galvanic current 
from zero up to comfortable tolerance, and maintain the 
current until the irrigator is empty, or for fifteen or more 



4i6 



TREATMENT OF PELVIC INFLAMMATION. 



minutes. Repeat this electrical application daily for a few 
days, if convenient. 

The solution distends the tissues, comes in contact with all 
parts and is a superb tonic as well as an electrolytic appli- 
cation. 

The. second stage of the case dates from the time when a 
cotton wrapped carbon electrode moistened in a warm soda- 
bicarbonate solution can comfortably be placed within the 
vagina and a galvanic current applied. 

When this stage is reached saturate a felt-covered, flat elecs. 
trode, 7X lo, in the usual hot-water solution of soda-bicarbonate 




Fig. 148. Fine felt or sponge covered electrode— assorted sizes with soft rubber 

insulating backs. 

and apply it to the abdomen with firm contact. For the first 
application connect this with the negative pole. 

Connect the positive galvanic pole with the carbon ball elec- 




Fig. 149. Carbon ball electrode. 



trode and wrap around it as large a pledget of absorbent cotton 
as can be inserted into the vaginal cavity without distress to 
the patient. Moisten it in the hot bicarbonate of soda solution. 



TREATMENT OF PELVIC INFLAMMATION. 417 

and either with or without a speculum insert it as deeply into 
the cavity as it will go, and support the handle without 
pressure. 

Gradually increase the constant galvanic current through the 
rheostat from zero up to about 20 mil., and after five minutes 
advance the current gradually to determine the maximum 
tolerance of the tissues. If this proves to be below 30 mil. 
the positive applications should be continued until sufficient 
sedative effect is produced to permit the use of the negative 
current without exciting fresh irritation. 

If the tolerance of the internal tissues comfortably demon- 
strates a capacity for 50 mil., the negative current may be em- 
ployed at the next sitting and thereafter conduct the case to 
a close. 

Follow each galvanic stance with the bipolar induction coil 
current which is to be continued as auxiliary to galvanic elec- 
trolysis, with applications merging gradually into the shorter 
coils and more tonic currents. As improvement progresses the 
bipolar part of the sitting is gradually reduced from twenty 
down to fifteen and ten minutes or less. 

If, at first use of the galvanic current, or at any subsequent 
time, a renewed irritation appears (not necessarily on account 
of the treatment) it is only required to return to bipolar 
faradic sedation and wait until the improved state is restored 
again. 

What may be called the third stage of treatment is the stage 
in which the electrolyzing action of the negative galvanic cur- 
rent can be applied locally for its softening, liquefying and 
absorbing action upon the inflammatory deposits. 

If the case is chronic when first seen the exact indications 
for preliminary treatment can be readily determined at the first 
examination. If bipolar faradic sedation is temporarily indi- 
cated it should be employed until it ceases to be called for. 
If the tissues are irritable, sensitive to pressure, soft and hyper- 
aemic so as to require the sedative, anti-congestive, astringent, 
drying, tonic, positive polar action of the constant galvanic 
27 



41 8 TREATMENT OF PELVIC INFLAMMATION. 

current, it should be employed after the first essential seances 
of bipolar sedation have paved the way. 

If the tissues are indurated and insensitive, so as to require 
and permit the softening, relaxing, liquefying, absorptive action 
of the negative galvanic pole, no previous applications of posi- 
tive need be made but the negative current can follow the 
usual introductory sitting of bipolar faradization. 

While any single term employed to designate a disease 
which passes through the complex stages of inflammation fails 
to present a clinical picture to the eye until the patient is seen 
and examined, yet the indication for the uses of the three 
great remedies — induction coil currents, positive and negative 
electrolysis — is clearly defined to the student of electro-physi- 
ology during the same examination which is required to arrive 
at even a partial diagnosis. 

Having now the state presented which demands negative 
electrolysis it will be necessary to rapidly push the current 
strength to a much greater amperage than before. The insen- 
sitive condition of the tissues will assist to permit this, but it 
must also be accomplished by management of the electrodes. 
When more than 50 or 60 mil. is used it is well to double the 
external electrode and place a pad upon both the lower abdo- 
men and the sacrum connected with a bifurcated cord. 

If the pelvis is large and will permit the insertion of the 





Fig. 150. Cup electrode for holding clay for application : three sizes. 

carbon ball wrapped with sufificient absorbent cotton to con- 
duct 75 mil. without burning effects it may be used up to this 
point, but as the best effects are sometimes only to be obtained 
in chronic indurations by the use of currents running up to 125 



TREATMENT OF PELVIC INFLAMMATION. 4I9 

mil., it is best to wrap the carbon ball with a thick layer of 
clay moistened to the consistency of putty and tied in place 
with a piece of cheese cloth and saturated with the usual warm 
water solution of bicarbonate of soda. This protection will 
safely apply currents of almost any therapeutic amperage 
without local injury to the surface of the mucous membranes. 

Repeat negative applications twice a week so long as symp- 
tomatic improvement continues. When this-finally ceases the 
general health of the patient may be maintained by an occa- 
sional return for applications whenever she feels any temporary 
aggravation. 

The prognosis in the very worst cases is better under skilful 
electrical treatment than under any other plan, and if the 
chronic case is so badly damaged that some form of operation 
is necessary electricity prepares the way for it and promotes 
recovery afterward. 

In the event that surgical measures are not required we may 
feel confident of procuring symptomatic relief and giving the 
patient a life of comparative comfort by the judicious use of 
the different electrical currents. Accessory intra-uterine or 
other applications are not referred to in this section although 
they are often an essential part of treatment, but they are fully 
described elsewhere and the practical physician will always 
attack the entire pathological condition. 

Of the results of treatment by methods which are here 
described Martin records : 

I have found the greatest satisfaction in treating inflam- 
matory exudations in the pelvis. This includes all cases from 
the simple thickening of one of the broad ligaments to com- 
plete fixation of all the organs of the pelvis with a thick un- 
yielding exudate matting everything together. The exudate 
will gradually but perceptibly disappear, the pain from pres- 
sure upon nerve fibres and nerve points will rapidly diminish, 
sympathetic disturbances will be relieved, displacements caused 
by contracting bands will gradually give way and the general 
mobility of the pelvic organs will return ; while coincidently 
the general health is restored from the effects of the improve- 
ment upon the general system. 



420 TREATMENT OF PELVIC INFLAMMATION. 

Clinical Remarks. — Some of the diseases of the uterus and 
uterine appendages are so associated together that clinical 
separation of the exact structures involved is either impossible 
or without therapeutic value. Other lesions are so obscure as 
to make an accurate diagnosis depend upon a surgical opera- 
tion or an autopsy. 

It is one of the happy consolations of electro-therapeutics 
that curative results are frequently achieved, or at least a 
symptomatic cure is effected, without regard to mistakes in 
scientific diagnosis. Even without any attempt to classify the 
lesion in terms of advanced nosology we may select and apply 
the various medical currents of electricity in accordance with 
unmistakable major indications which can successfully guide 
the therapeutist even when they fail the diagnostician. 

For the relief of symptoms within and without the pelvis 
dependent upon functional derangements or pathological but 
non-operative conditions I know of no remedy so reliable as 
skilfully handled electricity. The possession of improved ap- 
paratus and reasonable skill in technique will revolutionize the 
treatment of pelvic diseases so far as the individual physician 
is concerned, for it is impossible to witness the results and 
afterwards prefer the inferior topical applications and local 
methods which are so generally useless. 

The ordinary resources of medical gynecology may be judi- 
ciously employed to supplement the action of electro-thera- 
peutic currents, but considered separately and measured by 
recorded results it is a liberal estimate to credit them with 
20 per cent, of the efficiency of- electric currents in the treat- 
ment of some of the intractable conditions to which the prop- 
erties of electricity are adapted. 

With so much to commend them it may be asked, "Why are 
not electric currents in more general use in the treatment of 
disease, especially in oiiSce practice?" 

In reply it can be stated that their use is rapidly and steadily 
increasing. The medical world has never been so alive to their 
advantages as it is to-day, and Roentgen's discovery of a 



TREATMENT OF PELVIC INFLAMMATION. 42 1 

diagnostic aid which is becoming indispensable in surgical and 
medical examinations has revealed anew the great value of a 
therapeutic agent which medicine cannot do without. 

The variety of uses to which electrical currents are daily put, 
and the benefits accruing from them in medical practice, are 
not yet generally appreciated, but knowledge is now rapidly 
spreading and each year instructs a new generation of physi- 
cians in the A B C of the subject. 

Above all, however, enlightened discussion following upon 
the discovery of the X-rays has wiped out as with a sponge 
the strong prejudice which a long and hitherto uninter- 
rupted apathy on the part of medical colleges permitted to 
remain. 

The old physician may say: "Yes, we tried electricity 
twenty years ago, but it didn't work." The telephone didn't 
work twenty years ago, and X-rays didn't work two years ago. 
Strides have been taken in many directions since the Nestors 
of the profession went to school. Electricity is absolutely de- 
pendent for all its uses, whether these are scientific, industrial 
or medical, upon mechanical inventions ; and in common with 
the telephone, the phonograph, the electric motor and the elec- 
tric light, electro-medical apparatus has been developed by im- 
proved inventions. 

One by one the therapeutic Gordian knots have been cut, 
and instruments of scientific construction now produce each 
different medical current with facilities of control and modifi- 
cation which enable the experienced operator to demonstrate 
in clinical practice that electricity stands very near the first 
place among curative remedies within the field of its physio- 
logical action. 

Acute Catarrhal Endosalpingitis. — Supplementary to the 
ordinary method of treatment and absolute rest is vaginal bi- 
polar faradic sedation. It will lessen the tumefaction, conges- 
tion and pain, impart a very great sense of relief and repose and 
may be repeated as often as is required to maintain entire free- 
dom from pain. It renders opiates less needful and is much 



422 



TREATMENT OF PELVIC INFLAMMATION. 



more satisfactory. The technique is so often described in 
these pages that the reader is familiar with it. 

Subacute Catarrhal Endosalpingitis. — Maintain the vaginal 
bipolar faradic sedation as the chief treatment with a gradual 
increase of current strength as tolerance develops. One treat- 




Fig. 151. Bipolar vaginal electrode. 

ment per day is generally sufficient. As soon as it is indicated 
employ a mild positive galvanic current, with the carbon ball 
electrode covered with absorbent cotton and placed in the cul- 




Fig. 152. Carbon vaginal electrode with removable carbon tip. 



de-sac. Apply the negative electrode to the abdomen. Gradu- 
ally increase the constant galvanic current from zero up to 10 
at first, and, later, 20 to 30 mil. ; apply for ten minutes about 
three times a week, and follow each sitting with the usual 
bipolar sedation, which is still used daily. Intra-uterine appli- 
cations are neither necessary nor judicious. 

Chronic Catarrhal Endosalpingitis. — Vaginal bipolar farad- 
ization still remains the severeign remedy to relieve pain and 
tenderness, to hasten absorption and promote drainage by v/ay 
of the uterine canal. Rep&at daily, with the dosage propor- 
tioned to the tolerance of the tissues, and supplement the 



TREATMENT OF PELVIC I>fFLAMMATION. 



423 



sedative and tonic action of the high-tension induction coil 
current by the alterative and electrolytic properties of the 




Fig. 153. Bipolar electrode. 

positive galvanic current applied within the vagina by the car- 
bon ball electrode wrapped with absorbent cotton. 

In the more chronic stage the galvanic dosage which began 




Fig. 154. Carbon ball electrode. 



with 15 or 20 mil. may be gradually increased to 50 mil. It is 
greatly aided by the bipolar application which should be given 
immediately after at the same sitting. 

Catarrhal Salpingitis. — The indications for treatment in 
the acute or less chronic stages are to be found in pain, ten- 
derness and congestion. 

These ar'e~ always guiding symptoms for the use of 
vaginal bipolar faradic sedation. Initiate the treatment 
with this m,ethod and pursue it until all irritation has sub- 
sided. 

Then make a tentative trial of positive intra-uterine galvan- 
ism with mild currents. If there is any deficiency in drainage 
the negative pole should first be used to correct this, but the 
positive polar action is indicated for the inflammation. 

The method is that of treating simple endometritis. Either 



424 TREATMENT OF PELVIC INFLAMMATION. 

metallic electrolysis or simply the positive current with a 
platinum electrode may be used. Zinc amalgam electrolysis 
is often preferable. 

When the tubal inflammation does not subside entirely with 
an improvement in the endometritis, or is in the chronic stage 
when first seen, it calls for local positive galvanic treatment. 

Place a felt-covered, flat electrode, 7 X 10, upon the lower 




Fig. 155. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

abdomen, after saturating it with the invariable bicarbonate 
of soda solution. Connect it with the negative pole of the 
galvanic switchboard. Wrap the vaginal carbon ball electrode 
with as large a protecting mass of absorbent cotton as will 




Fig. 156. Carbon ball electrode. 

comfortably enter the cavity. Wet it with the warm soda-bi- 
carbonate solution and press it only just dry enough to prevent 
dripping. Insert it in the vagina so that it rests against the 
affected tube. Increase the positive galvanic current from 
zero up to comfortable tolerance, maintain for about ten min- 
utes and reduce gradually to zero. Close the sitting with a 
suitable tampon if the condition requires it. 



TREATMENT OF PELVIC INFLAMMATION. 425 

The galvanic dosage will vary with increasing improvement 
all the way from. 15 or 20 mil. at the first sitting to 35 
or 40 mil. after a few treatments, but this dosage will rarely 
need to be exceeded. When a tolerance of 40 mil. is reached 
the sittings may be repeated twice a week, and an inter- 
current treatment given with bipolar faradization. Adjuvant 
treatment must be carried out according to the needs of the 
individual case. 

The curative efficiency of bipolar faradization relates to the 
more acute and simpler cases, with little or no extension 
beyond the mucous lining of the tube. 

The palliative efficiency of bipolar faradization makes it a 
valuable remedy in all varieties and degrees of catarrhal salpin- 
gitis, even when the inflammatory process has spread deeper 
than above stated. 

The curative efficiency of the galvanic current relates to the 
more chronic forms, with extension of the inflammation into 
the interstitial and surrounding tissues, thickenings and other 
results short of pus. The presence of pus is a contra-indica- 
tion for local treatment until it is evacuated. 

The vaginal bipolar method, with a proper induction coil 
apparatus rightly adjusted, is safe in any careful physician's 
hands who has had a reasonable experience with it, but when 
galvanic currents are directed against inflammatory lesions of 
the uterine appendages the case should be in the hands of one 
who is competent to employ it. It requires very httle trouble 
and study to become practically conversant with the physi- 
ology and theraupeutics of galvanic currents, and it is certainly 
necessary for the physician to have some preliminary experi- 
ence before making applications which require ordinary skill, 

In some instances of suppurating salpingitis a free discharge 
of the pus and drainage through the uterus has followed an 
ordinary intra-uterine application of the negative galvanic 
current, which has apparently dilated the orifice of the tube. 
Some years ago Dr. W. B. Sprague reported a number of 
cases in which he had been able to empty the tubes. In some 



426 TREATMENT OF PELVIC INFLAMMATION. 

cases this is an accidental achievement, and in other cases it 
has been successfully accomplished by operators who have 
directed the intra-uterine electrode-sound so that it has entered 
the tube itself. In any case of suspected suppuration the intra- 
uterine negative application of the galvanic current should be 
limited to a mild dosage of under 30 mil. 

Remarks. — Tubal inflammations, whether first seen in the 
acute, sub-acute or chronic stage, or when undergoing acute 
aggravation, are all amenable to treatment with a fair prog- 
nosis, both as to relief of symptoms and final cure, by the 
conjoint employment of vaginal bipolar faradic sedation and 
vaginal applications of the galvanic current. 

Full details of these methods are repeated so many times in 
these pages that the reader is thoroughly familiar with them. 
Surgeons are apt to say that the treatment by electrical cur- 
rents is "tedious," but no one who has witnessed the some- 
times long lingering results of disappointing surger)', or 
experienced the tedium of routine gynecological practice, will 
fail to regard the resources of pelvic electro-therapeutics as a 
satisfactory means of obtaining satisfactory results. The value 
of an operative procedure is not to be measured by counting 
the minutes it takes to do it. Patients find this out by 
experience. 

Suppurative Salpingitis. — The failure of vaginal bipolar 
faradic sedation to relieve pain in any case of salpingitis points 
at once to the presence of a cause which it cannot reach. With 
pain due to distention of the tube, evacuation is the only thing 
that will afford relief. Many of these cases of purulent sal- 
pingitis are cure'd, and remain permanently cured, without 
removal of the appendages, or any other surgical operation 
which not only does not always cure the disease, but often 
leaves the patient in a worse state than before. 

The most experienced pelvic surgeons become most conserv- 
ative in removing tubes and ovaries until time and other 
methods of treatment have failed to relieve, and no case can 
be considered as having been thoroughly treated until the 



TREATMENT OF rELVIC INFLAMMATION. 427 

resources of skilled electro-therapeutics have been employed. 
A tube will often drain through the uterine cavity. 

The chief difference between the treatment of a suppurative 
salpingitis and a simple inflammation is the greater degree of 
caution that is required, and the operator must know how to 
correct possible aggravations by altering his technique to con- 
form to the individual case. 

While the presence of pus is cited as a contra-indication for 
electricity, and is in fact a contra-indication for certain forms 
of treatment, it is nevertheless no reason for debarring the 
patient from modified applications which are likely to do her 
good. That a tube may be made sufficiently patulous by 
negative intra-uterine galvanism to permit natural drainage has 
been demonstrated in a great many cases. 

When however the pains continue and the general condition 
is aggravated and the patient shows a decreasing instead of an 
increasing tolerance to the treatment, it is evident that the col- 
lection of pus cannot be evacuated by conservative measures 
with electricity. 

The positive pole of the galvanic current is generally contra- 
indicated in suppurative salpingitis. 

Treatment. — When the uterine end of the tube is patulous 
but the secretion drains imperfectly into the uterus, and when 
there is no acute inflammation present, the treatment is as 
follows : 

Moisten a felt-covered, flat electrode, about 6X9, in the hot- 
water bicarbonate of soda solution, connect it with the positive 
galvanic pole and place it over the hypogastrium. Wrap a 
protecting mass of absorbent cotton around the carbon ball 
electrode, saturate it in the same solution, connect it with the 
negative pole and insert it gently into the vagina so that the 
ball is in contact with the affected tissues. 

Very gradually increase the constant galvanic current from 
zero up to the point of comfortable tolerance, which at first 
may be only 20 or 30 mil. In about five minutes gradually 
reduce to zero and withdraw the electrode. Immediately in- 



428 



TREATMENT OF PELVIC INFLAMMATION. 




Fig. 157. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 




Fig. 1 58. Bipolar vaginal electrode. 

sert the vaginal bipolar electrode and stimulate peristaltic 
action by a rapidly interrupted high-tension current regulated 
to comfortable tolerance. 




Fig. 1 59. Carbon ball electrode. 

If pain is relieved, if the secretion is liquefied, and drainage 
improved after two or three tentative treatments of this kind, 
it may be considered that aggravations are not likely to be 
caused and we may proceed to more active measures. 

At the next sitting proceed precisely in the same way but 
substitute for the carbon ball an intra-uterine electrode-sound, 
connected with the negative pole. Adjust the dosage in the 
same manner and gradually carry it from 20 up to 50 or pos- 
sibly up to 80 mil. as tolerance increases and it becomes 
certain that no aggravation will be excited by the use of con* 



TREATMENT OF PELVIC INFLAMMATION. 429 

siderable current strength. Maintain the maximum dosagfe 
from three to five minutes, follow this with the usual bipolar 
faradic sedation, and carry out the general principles which I 



Fig. i6o. Intra-uterine electrodes. 



have described so that they are now familiar to the reader of 
these chapters. 

The negative intra-uterine action favors the escape of pus, 
which is often reported by the patient after only one or two 
treatments. It relieves congestion and quiets the pain, and 
when the conditions are not absolutely unfavorable (a rare 
case), it produces rapid improvement, which increases and per- 
sists. 

As a matter of fact the reader who will study the principles 
of treating inflammation, whether acute, chronic or suppurative 
by the aid of electrical currents will successfully carry out the 
same principles without discussion about the tissues involved. 

Abscess of Fallopian Tube. — In December of last year Mrs. 
L., widow, 22, had her menses suppressed by cold and had 
pelvic cellulitis and evidences of the formation of abscess in 
the left Fallopian tube or ovary. After general treatment it 
was deemed proper by consultants to make a laparotomy, but 
she objected, and after washing out the uterus repeatedly 
with sublimate solution, though not finding any evidence of 
intra-uterine disease, the experience of Dr. Lapthorne Smith 
occurred to me, and I introduced a uterine electrode and car- 
ried its point to, and possibly engaged it within, the left 
tube, connected it with the negative pole, placed the positive 
electrode in her hands and administered a current of 15 ma. 
carefully through Massey rheostat for eight minutes. This 
caused considerable pain, and rather severe back pains followed 
the treatment and continued for about two hours, when she 
suddenly got relief, and this was accompanied by a profuse flow 
of pus from the uterus. From this moment she improved, and 
about the only other treatment given was a hot vaginal douche 
of I to 4,000 solution of sublimate, twice daily. The discharge 



430 TREATMENT OF PELVIC INFLAMMATION. 

of pus continued freely for about three days and then grad- 
ually diminished and in the course of three weeks ceased. 
She passed the time for her next period without menstruating, 
except to the extent of a mere show on one day, and then 
began to suffer pains and. from abdominal tenderness ; and it 
seemed that she was likely to have another attack of inflam- 
mation and suppuration. Feeling sure now that the trouble 
came from stricture of the left tube I repeated the electrical 
treatment, but only using a current of lo ma. eight minutes. 
This was followed by backache and increased soreness about 
the left ovary, but during the night her courses came on freely 
and she afterward had no serious difficulty and has since 
menstruated regurlarly, and is now in perfect health. {Woolsey.) 

Remarks upon Suppurative Peri-Uterine Inflammations. 

— When it is known that an inflammatory process is purulent 
the resources of electro-therapeutics alone do not offer the 
ideal treatment. Sometimes they are valuable adjuncts, some- 
times they succeed fairly well, and in such desperate cases as 
septic peritonitis they are without avail. Nevertheless we must 
in electro-therapeutic practice find our patients in one or the 
other of the following classes : i. Those who are amenable to 
electrical treatment. 2. Those who are in a condition so bad 
that operation offers but little chance of recovery and the 
surgeon declines. 3. Those who should be operated upon but 
who positively refuse. 

In all but the rapidly fatal septic cases electro-therapy pro- 
vides safe and sometimes excellent palliative treatment. Some- 
times the aid of electricity will allow a very minor surgical 
operation to take the place of a more serious one. All methods 
must be employed as indicated to secure the best results, for 
no one branch of medicine covers the whole field of practice. 

Pelvic Haematoma and Haematocele. — When, in any case of 
this nature, it is deemed practicable to assist absorption by the 
aid of an electric current the expert may safely employ a 
valuable remedy which should never be attempted by the tyro. 

The immediate primary indications are thus given by an 
authority on the subject : " To check the hemorrhage when 
the case is seen early enough, to produce coagulation of the 



TREATMENT OF PELVIC INFLAMMATION. 



431 



diffused blood as quickly as possible^ and pievent a recurrence 
of the hemorrhage, to subdue pain and prevent inflammatory 
complications, to promote absorption and prevent suppuration 
and the formation of abscess, and by a speedy convalescence 
shorten the confinement in bed. The demonstrated positive 
polar actions of the galvanic current fulfil these indica- 
tions." 

With the patient in the dorsal position in bed place a felt- 
covered, flat electrode, 7 X 10, well moistened in a warm solution 




Fig. 161. Fine felt or sponge covered electrode — assorted sizes with soft rubbei 

insulating backs. 

of bicarbonate of soda (about a teaspoonful to the pint), upon 
the abdomen and a similar pad under the sacrum. Connect 





Fig. 162. Cup electrode for holding clay for application : three sizes. 



them with a bifurcated cord to the negative pole of a portable 
galvanic battery. 



432 TREATMENT OF PELVIC INFLAMMATION. 

Make up the clay-covered carbon vaginal electrode in the 
usual manner and moisten it thoroughly with the warm bicar- 
bonate of soda solution. Connect it with the positive galvanic 
pole and carefully insert it against the tumor. 

Increase the constant galvanic current with slow and per- 
sistent advances until the greatest tolerance of the internal 
electrode is reached. It may require fifteen minutes to attain 
the maximum current strength in a cautious manner, and the 
aid of a moderate or partial anaesthesia will be necessary if the 
patient is in great pain. 

When the current strength has been raised to the greatest 
possible amperage and passes the border line of tolerance, 
reduce it a few milliamperes to restore comfort to the patient, 
and maintain this maximum dose for about five minutes. 
Gradually reduce the current another lO mil. and withdraw 
the action very slowly until zero is reached. 

Repeat daily until hemorrhage not only ceases but pain is 
relieved and inflammation aborted. After the first application 
which accomplishes these effects the same treatment at longer 
intervals with milder dosage must be directed by the individual 
case. The indications later "for bipolar faradization will also 
be recognized and met. 



CHAPTER XXV. 

TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

Vaginismus. Treatment of simple and gonorrhoea! vaginitis. Vaginal leucor- 
rhoea. Prolapse of the vagina. Vulvitis. Pruritus vulva. Eczema of the 
vulva. Treatment of dyspareunia. Sterility. Treatment of uterine causes. 
Neuroses having their origin in uterine conditions. Urethritis in the female. 
Stricture of the female urethra. Functional disturbances of the urethra and 
bladder. 

Vaginismus. — Bipolar faradic sedation is the efficient and 
only needed remedy for this intense hyperaesthesia of the 
vulvar outlet and spasm of the constrictor vaginae muscle. 

Place the patient in the usual dorsal position upon the 
operating table, warm and lubricate the vaginal bipolar elec- 
trode and insert it carefully into the entire depth of the cavity. 
If nervous dread or spasm makes this at all difficult for the 
operator to do it may sometimes be more easily accomplished 
by the patient herself. 

After it is in position connect the conducting cords .so that 
the tip is positive and maintain it securely in position during 
the entire sitting. 




Fig. 163. Bipolar vaginal electrode. 

Switch the 1,500 yard No. 36 coil, the rapid vibrator and 

four cells into circuit. Increase the current from zero up to 

the point of comfortable tolerance, and in two or three moments 

again increase it until the current is as strong as the patient 

38 433 



434 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

can bear without fatigue or pain. If the 1,500 yai'd coil is not 
adequate to produce the desired dose switch the 1,000 yard No. 
36 coil and test its efificiency. 

Maintain a strong current for fifteen minutes and gradually 
reduce to zero. Repeat daily or every second day or at the 
convenience of the patient until relief is complete. Benefit 
will be obtained at the first sitting, and in a case of this kind 
without complications but very few treatments will be required. 
If the mucous membrane is dry the natural secretion will also 
be restored. 

The following case was treated by an inferior method but 
the result was satisfactory. 

Patient aged thirty ; since her marriage five years ago the 
trouble has gradually grown worse. The contractions' wpre 
most distressing, coming sometimes any hour during the day, 
especially when under any excitement ; a sudden change in 
position when asleep would also bring them on ; would last 
ten to thirty minutes. Has had two surgical operations per- 
formed with negative results. Two months after the last 
operation, when all other methods of relief had been exhausted, 
I commenced using faradic electricity. For my vaginal elec- 
trode I used a medium-sized Pratt's rectal dilator, to which 
was attached the rheophore from the positive pole — the other 
pole was placed over the uterus. The insertion of the dilator 
caused intense and painful contractions, which were partially 
relieved when the current was turned on. At first a mild 
current from a long-coil No. 32 wire was used for fifteen 
minutes. Each day the current was increased until it was as 
strong as could possibly be borne — it was then given twice a 
day and for forty-five minutes each time. Under this treat- 
ment there was a steady improvement until, at the expiration 
of three months, the patient declared herself relieved of the 
trouble. {Gardner}^ 

Vaginitis. — Simple acute and sub-acute inflammation of the 
vaginal mucous membrane may be satisfactorily treated by 
vaginal bipolar faradic sedation combined with some of the 
simpler accessory medication. The sedative coil current 
should be applied according to the directions given for the 
treatment of other acute pelvic inflammations (see IXDE.x) and 
repeated p. r. n. 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 435 

When the condition is chronic, and especially when gonor- 
rhoeal and accompanied with leucorrhoeal discharges, the 
superior method is the application of a galvanic current com- 
bined with an antiseptic solution by means of the hydro-elec- 
tric douche. 

Douche Method.— Moisten a felt-covered, flat electrode, 
7X 10, in a one per cent, hot-water bicarbonate of soda solution 
and apply it upon the abdomen with the patient in the dorsal 
position on the operating table. Connect this with the posi- 




Fig. 164. Electrode for vaginal hydro-electric applications. 

tive galvanic pole. Prepare about three quarts of any pre- 
ferred alkaline and antiseptic solution in the irrigating jar 
placed at a sufficient height to administer an ordinary vaginal 
douche. Attach the end of the rubber tube to the vaginal 
electrode and connect the electrode with the negative galvanic 
pole. Have the water hot. Whenthe electrode is inserted turn 
the stop-cock of the rubber tube and allow a continuous flow of 
the solution. Gradually increase the constant galvanic current 
from zero up to tolerance and maintain the current until the 
irrigator is empty, or for fifteen or more minutes. Prescribe 
other measures if indicated. Repeat the electrical application 
'^aily for a few days and three times a week until recovered. 

Gonorrhoeal Vaginitis. — Moisten a felt-covered, flat elec- 
trode, 7 X 10, in a one per cent, hot-water bicarbonate of soda 



436 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

solution and apply it upon the abdomen with the patient in 
the dorsal position on the operating table. Connect this with 
the positive galvanic pole. Prepare about three quarts of any 




Fig. 165. Electrode for va^nal hydro-electric applications. 

preferred alkaline and antiseptic solution in an irrigating jar 
placed at a sufficient height to administer an ordinary vaginal 
douche. Attach the end of the rubber tube to the vaginal 
electrode and connect the electrode with the negative galvanic 
pole. Have the water hot. When the electrode is inserted 
turn the stop-cock of the rubber tube and allow a continuous 
flow of the solution. Gradually increase the constant galvanic 
current from zero up to tolerance and maintain the current 
until the irrigator is empty, or for fifteen or more minutes. 
Repeat daily for a few days and three times a week until re- 
covered. 

Vaginal Leucorrhoea. — Moisten a felt-covered, flat electrode, 
7 X 10, in a one per cent, hot-water bicarbonate of soda solu- 
tion and apply it upon the abdomen with the patient in the 
dorsal position upon the operating table. Connect this with 
the positive galvanic pole. Prepare about three quarts of any 
preferred alkaline and antiseptic solution in an irrigating jar 
placed at sufficient height to administer an ordinary vaginal 
douche. Attach the end of the rubber tube to the vaginal 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 437 

electrode and connect the electrode with the negative galvanic 
pole. Have the water hot. When the electrode is inserted 
turn the stop-cock of the rubber tube and allow a continuous 
flow of the solution. Gradually increase the constant galvanic 
current from zero up to tolerance and maintain the current 
until the irrigator is empty, or for fifteen or more minutes. 
Prescribe any other measures indicated. Repeat the electrical 




Fig. 166. Electrode for vaginal liydro^electric applications. 



application daily for a few days and three times a week until 
recovered. 

Leucorrhceal discharges, either vaginal or uterine, need no 
separate consideration, and generally cease during the treat- 
ment of the catarrhal inflammation of which they are a symptom. 
Physicians who are not familiar with the action of the galvanic 
current may enquire how to treat such discharges, and this 
occasion is taken to say that the answer will be found under 
the caption of the causative lesion. 

Prolapse of the Vagina. — Surgical operations for the repair 
of a lacerated pelvic .floor are the theoretical means of cure. 
Practically they may be refused by the patient or she may be 
unable to have them done, orthe condition of the tissues may 
make their results unsatisfactory. Unless circumstances and 
the prognosis especially favor operative procedures the general 



438 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

practitioner and the patient may feel perfectly satisfied to 
resign Colporrhaphies, local astringents on tampons introduced 
daily in the vagina, pessaries and abdominal supports, arid in 
most cases of prolapse, rectocele and cystocele, with all their 
symptomatic distresses rely with confidence upon the efficient 
palliative, vaginal bipolar faradic stimulation. 

Place the patient in the usual dorsal position upon the oper- 
.ating table. 




Fig. 167. Bipolar vaginal electrode. 

Connect the tip of the vaginal bipolar electrode with the 
positive pole of the high-tension induction coil apparatus, the 
remaining half to the negative pole, and insert 'it well into the 
cul-de-sac of the vagina. 

Never use a speculum with this electrode. 

Switch into action the 1,500 yard No. 36 coil, the rapid vi- 
brator and four cells. 

If the increase of current from zero to the maximum E. M. 
F. with this coil produces a current which is scarcely felt by 
the patient proceed in the usual manner to test the shorter 
lengths of wire until the coil is found which produces an effi- 
cient contracting current. If tenderness, congestion and irri- 
tability are present the first few sittings will tolerate 
only a sedative current and the technique of bipolar faradic 
sedation must be employed. If there is no tenderness 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 439 

the treatment may proceed along the hnes of tonic faradiza- 
tion. 

Repeat sittings daily or every second day for a couple of 
weeks if the circumstances of the patient permit. She will 
rapidly reach a point of comparative comfort, and this may be 
maintained by ordinary care on her part and an occasional 
return for treatment when any relapse occurs. 

By this means she will escape both the dread of an operation 
and the endless bondage to tampons and pessaries which are 
but little less of a nuisance than the disease. If subinvolution 
or any other lesion requiring treatment is associated with the 
case it will share in the benefit of the bipolar application but 
should be attended to according to its own indications. 

The rapid relief from the discomfort, bearing down and 
aching pains, fatigue, heat and fullness at the vulva obtained 
by bipolar faradization are among the happiest effects within 
the range of its great clinical usefulness. 

Vulvitis. — The following method can be employed in any 
of the ordinary forms of this affection. 




Fig. 168. Electrode for vaginal hydro-electric applications. 

Moisten a felt-covered, flat electrode, 7 X 10, in a one per 
cent, hot-water bicarbonate of soda solution and apply it upon 
the abdomen with the patient in the dorsal position on the 
operating table. . Connect this with the positive galvanic pole. 



440 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

Prepare about three quarts of any preferred alkaline and 
antiseptic solution in an irrigating jar placed at a sufificient 
height to administer an ordinary vaginal douche. Attach the 
end of the rubber tube to the vaginal electrode and connect 
the electrode with the negative galvanic pole. Have the water 
hot. 

When the electrode is inserted turn the stop-cock of the 
rubber tube and allow a continuous flow of the solution. 
Gradually increase the constant galvanic current from zero up 
to about lO mil. and maintain the current until the irrigator is 
empty, or for fifteen or more minutes. Prescribe other meas- 
ures indicated in each individual case, repeat the electrical 
application daily for a few days and three times a week until 
recovered. 

Support the electrode loosely so that the solution will come 
in contact with the labia. 

Pruritus Vulva — Moisten a felt-covered, flat electrode, 
7 X lO, in a one per cent, hot-water bicarbonate of soda solution 
and apply it upon the abdomen with the patient in the dorsal 
position on the operating table. Connect this with the positive 




Fig. 169. Electrode for vaginal hydro-electric applications. 



galvanic pole. Prepare about three quarts of a semi-saturated 
rock salt solution in an irrigating jar placed at a sufificient 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. / 

height to administer an ordinary vaginal douche. Attach 
end of the rubber tube to the vaginal electrode and conn 
the electrode with the negative galvanic pole. Have 
water hot. When the electrode is inserted turn the stop-c< 
of the rubber tube and allow a continuous flow of the soluti 
Gradually increase the constant galvanic current from z 
up to tolerance and maintain the current until the irriga 
is empty, or for fifteen or more minutes. Support the electr< 
loosely, so that the flow will come in contact with the affec 
parts. 

Repeat daily till relieved. If the condition is a sympt 
of diabetes treat the patient by static electricity also. (! 
Diabetes for clinical directions.) 

Eczema of the Vulva. — After the application of the hyc 
electric vaginal douche in the usual manner supplement 
action by the external spray directed upon the eczemati 
tissues. 

Moisten a felt-covered, flat electrode, 7X lO, in a one 




Fig. 170. Fine felt or sponee covered electrode — assorted sizes with soft ru 

insulating backs. 



cent, hot-water bicarbonate of soda solution and apply it u] 
the abdomen with the patient in the dorsal position on 
operating table. Connect this with the positive galvanic p 
Prepare about three quarts of any preferred alkaline and 



442 TREATMENT OF MISCELLANEOUS PELVIC CONDI'TIONS. 

tiseptic solution in the irrigating jar placed at a sufficient 
height to administer an ordinary vaginal douche". Attach the 
end of the rubber tube to the vaginal electrode and connect 
the electrode to the negative galvanic pole. Have the water 
hot. When the electrode is inserted turn the stop-cock of the 
rubber tube and allow a continuous flow of the solution. Im- 
mediately increase the constant galvanic current from zero up 
to about 30 mil. and maintain the current until the irrigator is 
two-thirds empty. 

Reduce the current to zero, turn the stop-cock to shut off 
the flow of water, withdraw the vaginal electrode and substitute 
the spray electrode for external use. Again start the flow of 




Fig. 171. Hydro-electric spray. 

both the water and the current and use the remaining third of 
the solution directly upon the surface of the lesion. 

Repeat daily at first or every second day until improvement 
is sufficient. Prescribe for the general condition of the patient 
and especially take into account any indications for the em- 
ployment of static electricity, which benefits so many of these 
patients. 

Dyspareunia. — This frequent symptom may exist in various 
degrees, from mere discomfort to intense suffering, but some 
of its most common causes are entirely removable by electrical 
treatment. Special applications must be directed to special 
causes, but in the majority of simple conditions the local hy- 
persesthesia and tenderness is admirably relieved by vaginal 
bipolar faradic sedation. This is often the sheet-anchor of 
treatment for pelvic pain and tenderness, and if an examina- 
tion reveals no lesion requiring other methods it should not 
only be employed at first but repeated p. r. n. Some of the 
more common affections which produce this symptom are : 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 443 

Vaginismus. — This requires little other treatment than bi- 
polar faradic sedation. 

Vaginal or vulvar hyperczsthesia. — Vaginal bipolar faradic 
sedation \s facile princeps in the curative treatment of this 
condition. 

Lacerations of the cervix uteri. — When these are of a 
minor character a normal condition may often be restored 
without an operation by negative galvanic electrolysis com- 
bined with dilute nitric acid. The method is fully described 
under lacerations of the cervix. (See INDEX.) 

Inflammations of the uterus. — These are best treated by 
vaginal bipolar faradic sedation combined with galvanic cur- 
rents. After making a diagnosis the reader may turn to the 
index of this book for a complete description of the technique 
adapted to different degrees of inflammation. Other lesions 
of which the same may be said are diseases of the cervix 
uteri, displacements of the uterus, prolapsed ovaries, ovari- 
tis and pelvic inflammatory exudations, all of which are con- 
sidered under their appropriate headings. 

Urethral caruncles — may be subjected to galvanic puncture. 

Fissure of the ostium vagins — may be remedied by a few 
applications of cupric electrolysis. 

Fissure of the anus, rectal ulcers and hemorrhoids — may be 
successfully treated by metallic electrolysis or negative elec- 
trolysis. 

Almost all the conditions which produce dyspareunia, except 
those of an anatomical character, find among the resources of 
electro-therapeutics the practical means of relief. 

Sterility. — -The treatment of this condition so far as it 
relates to unfavorable conditions of the female pelvic organs 
resolves itself into the treatment of some one or more of the 
familiar lesions in which the curative value of electric currents 
has been effectually demonstrated. 

Such causes as may be included under obstructions of the uter- 
ine canal either by stenoses of the internal Os or flexions and 
displacements of the uterus may often be effectively relieved by 



444 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

negative galvanic electrolysis and measures described under 
other headings. 

If sterility is apparently due to a diseased condition of the 
uterine membrane, this may be put in a healthy state by the 
aid of either positive or negative intra-uterine applications 
according to the local indication. 

If simple stimulation of functional activity is desired the 
negative pole is employed. 

If there is a catarrhal endometritis it should be treated with 
the positive pole. In some cases no catarrhal process may be 
suspected and yet exist in a mild form. The positive galvanic 
current will correct this. 

In one case in my own practice pregnancy followed upon a 
course of vaginal bipolar faradization after three years of 
sterility and nearly a year of the usual routine treatment of 
dysmenorrhcea by an excellent physician who, however, de- 
prived himself of the advantages of medical electricity. 

When no apparent lesion can be made out by careful exam- 
ination an appropriate method is a mild stimulation of the 
endometrium by a negative galvanic current of about 20 mil., 
and there is no doubt of the happy effect of simple bipolar 
faradization upon functional lack of tone. 

Sterility has been associated with dysmenorrhcea in a great 
many cases, and this has led to a large experience with the 
action of both positive and negative galvanic currents in all 
doses upon the endometrium, for patients desire treatment for 
pain when the mere fact of sterility is negligible. The restor- 
ative action of these currents even in maximum cauterizing 
doses has resulted in many cases of pregnancy following elec- 
trical treatment. Those who created imaginary alarm five or 
ten years ago by stating that electric currents caused adhesions, 
atresia and sterility never had any clinical ground to stand 
on. 

Sterility is more often due to endometritis, with the conse- 
quent alteration in the secretion from the uterine and cervical 
membrane, and evidence of congestion is found in the uterine 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIOTSTS. 44$ 

and peri-uterine tenderness discovered by digital examina- 
tion. 

These cases make up the majority of those which are met 
in practice when more serious complications are absent, and 
they may all be treated upon the same principles. 

At the first examination, with the patient in the dorsal 
position on the operating table, warm, lubricate and insert the 
vaginal bipolar electrode and connect the tip with the positive 




Fig. 172. Bipolar vaginal electrode. 

pole of the high-tension induction coil apparatus. Connect the 
opposite half of the electrode with the negative pole. 

Switch the 1,500 yard No. 36 coil, the rapid vibrator and 
four cells into circuit. Gradually increase the current through 
the rheostat from zero up to the point of producing moderate 
sensation, and if the patient is either nervous or extremely 
sensitive use care in carrying the dose beyond this point at the 
first sitting, for it is more important to compose the patient, 
allay her nervous fears and obtain her confidence in the treat- 
ment than it is to hurt her and never see her again. 

Having carefully advanced the current strength to the point 
of comfortable tolerance, maintain it for about ten minutes and 
gradually reduce to zero. Repeat sittings every second day for 
one or two weeks, during which time it will ordinarily be found 
that tenderness is entirely removed and signs of local conges- 
tion are no longer present. 

In any state of marked hyperaesthesia without grave symp- 
toms there is never any particular hurry to invade the uterine 
canal, and patients as a rule will appreciate a little conserva- 
tism on this point. 

After a suiificient number of sittings to produce complete 
sedation by the bipolar method we may next place a well moist- 



446 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

ened felt-covered, flat electrode, 6X8, under the sacrum and 
cautiously insert either a platinum oV pure tin electrode-sound. 




Fig. 173. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

If entrance into the uterus is attended with any spasm at the 
internal Os, or marked sensitiveness, or discovers any point of 
ejitreme local tenderness, connect the intra-uterine electrode 



Fig. 174. Intra-uterine electrode, 

with the positive galvanic pole and the external electrode with 
the negative. 

Gradually increase the constant galvanic current from zero 
up to 10, 15 or 20 mil., stopping at the first sign of unpleasant 
sensation. Maintain the current just below the point of dis- 
comfort for a couple of moments and again increase the 
strength a few mil. In all cases in which the tolerance im- 
proves it may be accepted as an indication that the treatment 
is both proper and beneficial, for if it was doing harm the toler- 
ance would decrease. 

The length of sittings with these mild currents may be about 
ten minutes, repeated about three times a week between 
menstrual periods. 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 447 

If the passage of the electrode discovers none of the usual 
indications for the positive pole but encounters instead a 
stenosis of the internal Os or an anaemic condition the elec- 
trode should be connected with the negative pole and the 
external electrode made positive. The remainder of the treat- 
ment including the regulation of the dose, duration and fre- 
quency of treatment is the same whichever pole is employed. 
The amount of treatment required will be developed by the 
course of events. If the next period, or the next after the 
first, is free from pain and more normal in character treatment 
may be stopped until a sufficient lapse of time determines the 
result. 

Neuroses having their Origin in Uterine Conditions. — 
These neuroses may be nervous dyspepsias, headaches, neu- 
ralgias, general irritability, or run the whole gamut of hysteria. 

When associated with palpable lesions of the uterus or ad- 
nexa they will improve under the c6njoint action of vaginal 
bipolar faradization and intra-pelvic applications of galvanic 
currents. If a uterine cause is suspected but cannot be made 
out there are three methods of practical value in electro-thera- 
peutics which are more satisfactory from a clinical standpoint 
than any of the ordinary forms of prescribing. 

1. Percutaneous galvanism through the pelvic organs. 

2. Vaginal bipolar faradization. 

3 General and localized static electrification adapted to the 
symptomatic needs of the patient. 

If the neurosis is related to functional disturbances of the 
pelvic viscera or nerve supply the relief afforded by one or 
more of these methods may be complete. In direct proportion 
as the neurosis is vague, elusive and apparently without a local 
habitation or a name, the difficulties of treatment by either 
medicine or other measures are simplified by these three pro- 
cedures, and static electricity is my first choice. 

Study the chapter upon the treatment of functional nervous 
diseases, and when once the knack of managing nervous 
patients upon the platform of the static apparatus has been 



448 TREATMENT OF MISCELLAfJEOUS PELVIC CONDITIONS.. . 

acquired the physician has the means of treating with satis- 
faction a class of cases which otherwise are among the trying 
experiences of medical life. 

If the static machine performed nothing else in the treat- 
ment of disease it confers a lasting benefit upon all who use 
it by the masterful manner in which it often conquers vague 
neuroses of rebellious kinds. 

I speak of this with a particular sense of gratitude to this 
magnificent apparatus on account of its many services to me 
in simplifying the treatment of neurotic and hysterical patients. 

Urethritis in the Female. — The treatment of catarrhal in- 
flammations of various stages and degrees constitutes the chief 
field of metallic electrolysis. 

Place a felt-covered, flat electrode, 6X8, well moistened in 




Fig. 175. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

the usual hot-water solution of bicarbonate of soda, upon the 
lower abdomen, or under the sacrum, whichever is most con- 
venient. Connect this electrode with the negative pole of the 
galvanic apparatus. 

Select for the positive electrode a sound of zinc or copper 
that will conform to the urethral canal and come in contact 
with the entire surface. 

For the reason that it is non-irritating and does not adhere 
to the tissues, the zinc-amalgamated electrode is often prefer- 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 449 

able. Select a zinc electrode-sound of proper size and- brighten 
the surface with fine emery cloth. Next amalgamate the zinc 
surface with mercury and after connecting it with the positive 
pole of the battery insert it into the canal. 




Fig. 176. 

Gradually increase the constant galvanic current through the 
rheostat from zero up to about 20 mil., or the point of com- 
fortable tolerance, which will vary with the stage of the in- 
flammation. Maintain the maximum current about five min- 
utes and gradually reduce to zero. 

Repeat the application several times, at intervals of about 
four days. 

If the catarrhal process is purulent and the application is 
well borne it may be repeated every second day until improve- 
ment permits longer intervals. 

Strictures of the Female Urethra, — An infiltrated strict- 
ure which is the result of urethritis is rapidly and radically 
cured by the action of the negative galvanic current in doses 
of from 3 to 10 mil., applied by the same method as treatment 
for stenosis of the internal Os of the uterus. 

Cicatricial stricture resulting from traumatism may be at-- 
tacked by the same electrolytic action, but yields far less 
readily. When results are secured they are practically free 
from relapse and possess advantages over gradual or rapid 
dilatation or cutting. 

Moisten a flat, felt-covered electrode, 6X9, in the usual hot- 
water solution of bicarbonate of soda and place it either upon 
the lower abdomen or under the sacrum, the latter situation be- 
ing almost always the most convenient. Connect this electrode 
with the positive pole of the galvanic battery. 

Select one of the same electrodes employed for the treat- 
ment of stenosis but of a size a little too large to pass through 
29 



450 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 

the stricture by simple pressure. Connect this electrodewith 
the negative pole, pass it through the flame of an alcohol lamp 




P'S- I??- 'ine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

to sterilize it, dip it in glycerine to lubricate it, and insert it into 
the canal as far as it will go. 

Gradually increase the constant galvanic current through the 




Fig. 178. Set of olive electrodes. 




Handle for same. 

rheostat until it produces a sensation of very gentle warmth 
without the slightest discomfort or pain. Unless the electrode 
is very small the meter should register 5 or 7 mil., or not over 
10 with a large electrode. 

Maintain the constant action of the current until the elec- 
trode passes the stricture and is again withdrawn through it 
backwards. Sufificient time should be taken to accomplish 
this without force, but ordinarily from 12 to 20 minutes may 



TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 45 1 

be allowed for the entire application. As soon as the electrode 
passes the stricture in the reverse direction reduce the current 
gradually to zero and finally withdraw the electrode and close 
the sitting. Repeat about once a week. 

If any irritation exists it must be allayed by the usual 
methods before electrolytic treatment is begun. If any fresh 
aggravation occurs during a course of treatment allow an 
interval for sedative treatment before the next galvanic appli- 
cation. 

The number of treatments required will be a dozen or less 
in a case of a single fibro-plastic deposit, up to six months or 
more of patient treatment if the cicatrix is old and firm and 
especially if the strictures are multiple. See also treatment of 
stricture in the male for description of Linear Electrolysis. 

Functional Disturbances of the Urethra and Blad- 
der. — Although directions for local applications of both gal- 
vanic and faradic current are given in various text books for 
the treatment of enuresis, neuralgic and spasmodic symptoms 
and other neuroses of the female urethra and bladder in both 
women and young girls, yet such methods are not always 
acceptable to patients, nor always feasible for the general 
practitioner. The practical mind would only consider their 
employment as a last resort, and even as a last resort they are 
not very satisfactory, particularly when inferior apparatus is 
used. 

Whatever can be done however to relieve these derange- 
ments with static electricity is both practical and acceptable, 
for neither disrobing nor exposure of the patient is required 
and there is very little tax upon either the operator or the 
patient. 

Seat the patient upon the static platform and connect it 
with the positive pole. Ground the negative pole and limit 
the first application to about fifteen minutes of sedative-tonic 
electrification only, if the patient is neurasthenic and timid 
and requires some improvement in general health before 
attending to local symptoms. 



452 TREATMENT OF MISCELLANEOUS PELVIC CONDITIONS. 



After the first sitting and as soon as local applications can 
be agreeably made apply a persistent sedative breeze both to 
the cervical and lumbar spine 3ind over the region of the bladder. 
Within two or three sittings the average patient will be suffi- 
ciently improved to permit the use of counter-irritant applica- 
tions, for which the preliminary steps have prepared the way. 
The static breeze is especially useful in the burning pains of 
strangury and aids other treatment. 

For the various modifications of technique refer to the 
chapter upon how to produce special therapeutic effects. 

Enuresis will require in addition a stimulus to the sphincter 
muscles, and this is sometimes effectively obtained by means 
of mild static sparks to the perineum and lumbar spine. Have 
the patient sit well forward upon the edge of the chair on the 
platform connected with the negative pole. 

Ground the positive pole and the electrode called the " spark 




Fig. 179. Insulated spark electrode. 

director" to the same grounding. Have the patient spread 
the limbs apart and adjust the clothing so that a few mild 
sparks may be directed as nearly as possible to the perineal 
region. 

Repeat treatment daily, or every second day until relieved. 



CHAPTER XXVI. 

TREATMENT OF EXTRA-UTERINE PREGNANCY. 

Method of galvanic application. Method of faradic application. A clinical ex. 
ample treated by each current. 

Extra-Uterine Pregnancy. — Treatment of this condition 
by electric currents is limited to the time prior to rupture 
when conservative measures are deemed indicated. From 
whatever point of view the advocates of the knife as the "ideal 
treatment of ectopic gestation " may present their claims it is 
quite certain that some patients will prefer the safe and almost 
certainly effective methods of galvanic or induction currents. 
It is necessary therefore to describe the technique in full. 

Galvanic. — The absence of any urgent need for immediate 
operation is sufficient warrant for the employment of galvanic 
electricity. If the diagnosis proves to be a mistake there is 
. nothing with which the condition could be confounded that 
would be harmed by the electrical treatment, and but one 
thing (a tumor containing pus) which would not derive 
benefit from the methods employed to cause the absorption of 
the tubal mass. The objections therefore to electricity could 
hardly be less, and since it composes the nervous system of 
the patient and relieves pain at the same time it is silently 
attacking the tumor, without causing any of the alarming 
disturbances and fears that often accompany grave surgical 
operations, the employment of this agent is indicated by re- 
gard for the patient's welfare. It passed beyond the experi- 
mental stage nearly ten years ago. 

Place the patient in the dorsal position in bed, with the 
limbs flexed and knees apart, so as to afTord the operator free 
access to the vaginal cavity. If the patient is in a nervous 

453 



454 



TREATMENT OF EXTRA-UTERINE PREGNANCY. 



and hypersensitive state administer a hypodermic injection of 
morphine. Also irrigate the vagina with a cleansing solution 
if convenient, although this is not absolutely necessary. If 
digital examination reveals great tenderness it should be 
allayed by a ten-minute application of vaginal bipolar faradic 
sedation. 

Carefully insert the vaginal bipolar electrode in the usual 
manner and begin the dose regulation with the 1,500 yard No. 




Fig. 180. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 




Fig. 181. Bipolar vaginal electrode. 

36 coil, the rapid vibrator and four cells in circuit. Increase 
the dose from zero until the current produces a comfortable 
sensation with increasing relief to the patient. This may in 
one case require a 1,500 yard coil with less than the E. M. F. 
of four cells or in another case may require the 1,000 yard coil 
No. 36 wire, or even 800 yards of No. 32 wire with E. M. F. 
of between three and four cells. To ascertain the correct 
current strength is the work of a moment only. The sedative- 
tonic current should be applied for about fifteen minutes. 

Next saturate a felt-covered, flat electrode, 7 X 10, in the in- 
variable hot-water solution of bicarbonate of soda, press it only 



TREATMENT OF EXTRA-UTERlNE PREGNANCY. 4S5 

moderately dry, and apply it to the abdomen directly over the 
site of the tumor. Connect it with the negative pole of the 
galvanic battery. 

Wrap the carbon ball electrode with a mass of protecting 
absorbent cotton as large as can be comfortably inserted in 
the cavity. Saturate it in the same bicarbonate of soda solu- 
tion and insert it through a speculum, allowing it to retain as 
much moisture as possible, for the wetter it is, the better con- 




Fig. 182. Carbon ball electrode. 



ductor it is. Support it gently against the tubal mass and 
connect it with the positive pole. 

Gradually increase the constant galvanic current from zero 
until the meter registers about 50 mil., if the tissues are not 
intolerant of this dosage. Maintain the maximum current for 
at least five minutes, and if it is perfectly comfortable to the 
patient continue it for eight minutes. Then gradually reduce 
to zero and close the first sitting. 

Repeat the same applications on the second day following 
with a dose of 60 mil., and if no evidences of any impending 
rupture have appeared close the second constant current appli- 
cation, in the following manner. 

After reducing the current to zero switch the slow inter- 
rupter into circuit (if the apparatus contains one) and again 
increase the current strength from zero until contractions are 
felt by the patient. Do not make them so strong as to cause 
discomfort to the patient or incur risk of rupturing the sac, 
although the action of the galvanic current is not likely to do 
this. Extreme violence is not required, however, and the 
ordinary rules of careful dose regulation apply here. 

The rate of interruption should be from 50 to 70 per 
minute, and if the switchboard possess no automatic rheotome 
the operator may interrupt the current by hand. One or two 



456 



TREATMENT OF EXTRA-UTERINE PREGNANCY. 



minutes is sufficient time to employ the interrupted current 
at first. 

Repeat exactly the same applications two days later, and if 
the tissues develop an increasing tolerance the constant current 
should be increased to fully 75 mil., although the regulation in 
each individual case must be directed by medical judgment. 

After about six applications the prognosis in the case will 
determine the course of future treatment. After the patient 
is convalescent and requires only symptomatic treatment, this 
will mainly depend upon the local indications, but the chief re- 
sources will be bipolar faradization and vaginal, or, possibly, 
intra-uterine positive or negative galvanic currents. 

Faradic. — Although every physician should have a galvanic 
apparatus, yet in case a faradic current is the only one accessi- 
ble, it may be employed as follows : 

Place a well-moistened felt-covered, flat electrode, 6X9, upon 








Fig. 183. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

the abdomen over the site of the tumor. Connect it with the 
positive pole of the high-tension induction coil apparatus. The 
negative electrode may be either inserted in the vagina or in 




Fig. 184. Curved vaginal electrode. 



TREATMENT OF EXTRA-UTERINE PREGNANCY. 457 

the rectum behind the tumor. The choice of these situations 
depends on the situation of the mass. Employ the one which 
will bring the current most directly in contact. 

Switch the 500 yard No. 32 and entire No. 21 wire coils, the 
rapid vibrator and four cells into circuit. Gradually increase 
the current strength through the rheostat until it is percepti- 
bly felt a;t the internal electrode.. After about ten minutes re- 
duce the current to zero and close the sitting. 

Repeat on the second day, and if no signs of threatening 
rupture have been discovered, add to the ordinary action of 
the current a few strong single contact impulses made in the 
following manner : 

With the current strength raised to its point of maximum 
tolerance switch the cells abruptly out of circuit ; then switch 
them suddenly in again, and repeat this manoeuvre about thirty 
or forty times during the last minute of the application. This 
produces an effect, similar to that of a slow interrupter, which 
may be used if desired. 

The faradic current is not so effectual as the galvanic cur- 
rent, and before employing vigorous interruptions it should be 
determined whether or not the sac is so tense that stimulation 
of muscular action would endanger safety. 

As the majority of physicians could employ either of these 
methods even if they were without facilities for a laparotomy, 
and as in some cases the patient would be subjected to a 
greater tax simply to recover from the surgical operation than 
the entire electrical treatment would involve, there is abundant 
argument as to which method to advise during all the very 
early period of extra-uterine pregnancy and prior to impending 
rupture. 

For the permanent re-establishment of general health when 
absorption is safely progressing and the patient stands in need 
of tonic and nutritional remedies, the static machine and 
vaginal bipolar faradization are both of great utility. Every 
physician who understands the general applications of these 
methods will find them invaluable. They are to be em- 



458 TREATMENT OF EXTRA-UTERINE PREGNANCY. 

ployed according to the rules laid down under special head- 
ings. 

Remarks.— Although so many cases of the satisfactory treat- 
ment of extra-uterine pregnancy by both galvanic and faradic 
currents have been reported in medical journals during the 
past ten years, I will cite an instance of each method so that 
the reader may have before him a clinical example for refer- 
ence. 

Tubal Pregnancy Treated by Galvanic Currents. — Mrs. 

E , aged 33, mother of two children, aged five and one-half 

and three and one-half years. Last regular menstruation, 
March 22. April 23 to 30, flow absent, slight nausea, repeated 
severe colicky pains in lower part of abdomen, especially on 
right side. 

May I. Uterus of normal size, slightly retroverted, external 
Os somewhat small and slightly patulous. To right of fundus 
a small tender mass, taken at the time for a partially prolapsed 
and probably inflamed right ovary. Excessive tenderness pre- 
vented a thorough search for the right. ovary in its normal 
position. 

May 5 to 13. Metrorrhagia more free than at periods, accom- 
panied by colicky pains and the discharge of a few small 
shreds. Tubal pregnancy strongly suspected. Hemorrhage 
controlled by tamponing vagina with iodoform gauze. 

May 13 to 21. No further hemorrhage, but persistent col- 
icky pains, and pains down anterior part of right side. Daily 
examination showed mass to right of uterus to be steadily and 
rapidly increasing in size. A positive diagnosis of tubal preg- 
nancy of the right side was now made, based upon the follow- 
ing consideration : 

I. The symptoms of an incipient gestation. 2. The develop- 
ment and rapid steady growth of a tumor in the region of the 
right tube where it was positively known that nothing abnormal 
had previously existed. 3. The accompanying metrorrhagia, 
labor-like pains, and the passage of shreds. 

On May 22, while returning from the ofifice of a consultant, 
the patient was suddenly taken with the most excruciating ab- 
domirial pains, fainting, vertigo, and symptoms of collapse. 
Her pulse became rapid, small, and thready, and her counte- 
nance blanched. After reaching home with difficulty, a hypo- 
dermic of 15 minims, of Magendie's solution was followed 
by cessation of pain and an improvement of general symptoms. 
Electrical foeticide was agreed upon by the advice of Dr. T. G, 
Thomas. 



TREATMENT OF EXTRA-UTERINE PREGNANCY. 459 

May 23. (The electrical administration with the galvanic cur- 
rent was rather crude and inferior to that described by the 
author above, and need not be repeated here in detail.) 

The applications were repeated on May 25, 27, 30, June 3 
and 6 — six applications in all. During this time the patient 
suffered much from pains in the lower part of the abdomen, 
more of a quiet and steady character than of the previous col- 
icky nature, and accompanied by a slight rise of temperature 
(ioo|°) and pains and soreness in the abdominal muscles. The 
latter I attributed to the violent contractions produced by the 
electricity. The pains on two occasions called for hypoder- 
mics of morphine for their relief. 

(The application reported was unnecessarily violent and was 
not preceded or followed by bipolar sedation, hence disturb- 
ances resulted which were the fault of the operator. — AUTHOR.) 

June 15, menses reappeared, normal in duration and 
amount, and painless. 

Cessation of the growth of the tumor was verified by 
examination. 

November 21, patient has remained perfectly well since 
June 6. 

On two occasions excessive exertion was followed by dull 
pain in the right groin lasting for one day. With this excep- 
tion there has been absolutely nothing to remind her of her 
former trouble. Examinations at intervals have enabled me 
to follow the gradual diminution in size and the final dis- 
appearance of the mass without any further treatment. 

To-day nothing abnormal can be found in the pelvis by bi- 
manual examination. I report the case because the diagnosis, 
carefully and deliberately arrived at and confirmed by two 
eminent authorities, cannot reasonably be questioned, and- 
because of the entirely satisfactory results of the galvanic 
treatment — destruction of the foetus and its complete absorp- 
tion within six months, without having exposed the mother 
to the perils and possible sequelae of a laparotomy. {Edebohls^ 

Tubal Pregnancy Treated by Induction Coil Current. Mrs. 

S , aged 23, one child four years previous. First examined 

by me on September 24. 

She had complained since August 12. Menstruation should 
have occurred on the 12th, but was deferred until the 14th, 
when there was a slight show, which ceased after two days, to 
reappear, but only as a stain, through the remaining days of 
August and up to September 19th. She had just previous to 
this last date made the journey to town, about twenty miles. 
The flow stopped two days and again began. 



460 TREATMENT OF EXTRA-UTERINE PREGNANCY. 

Besides the protracted inconsiderable flow, the patient suf- 
fered from constant heavy pain and tenderness in the lower 
part of the abdomen, chiefly in the left inguinal region. 

My partner saw Mrs. S at her country home, August 

27th, but she declined to have an examination. 

September 8th, the date of menstrual epoch, she had, as 
she described it, a dreadful attack of pain, accompanied and 
followed by abdominal soreness, but no increase of flow. 

September nth, she had another very violent and persistent 
attack of pain. To her friends she seemed almost in collapse. 
" She looked like a dead person, deep circles under her eyes, 
and her face drawn and pinched, with cold forehead, nose and 
chin." 

September 14th, she was removed to town, and was seem- 
ingly somewhat improved. 

September 24th, late in the evening I was called to see Mrs. 

S , and found her in pain, which to my judgment was very 

intense, though said to be less severe than previous ones. It 
was relieved by the hypodermic needle with morphia ; and 1 
made a vaginal examination. This showed the uterus to be in 
right retro-latero version, moderately fixed, and slightly en- 
larged. Save the slight enlargement, the condition of the 
uterus was the same as at the previous examination. 

On the left side lying low down, but easily separable from 
the body of the uterus, I could by the bimanual method read- 
ily define a semi-fluctuating tumor, in size and shape like the 
bulb of a Davidson's syringe, perfectly movable, but exquis- 
itely tender. 

This was described as the site of all previous pain and 
soreness. 

I recognized it as a probable, extra-uterine tubal pregnancy. 
This I must confess had not, until this examination, occurred 
to me as the condition likely to be found. 

Inquiries made after this vaginal examination brought out 
the facts of quite constant nausea during the rhonth of August, 
and the breast signs were also those of pregnancy. 

I much desired a consultation, but Iwas afraid to have it, 
for I feared that I might risk my patient's life were surgical 
treatment adopted. I determined to delay at least a day or 
two, treating the patient and holding the surgical procedure 
in reserve. The sac, though very tender to touch, did not seem 
so tense as to excite alarm that it would burst at once. I 
waited for Dr. T. G. Thomas, who was out of town, thinking he 
would agree with me in methods to be used. 

September 25th. With the patient on the back, brought to 
the edge of the bed in the French obstetric position, I intro- 



TREATMENT OF EXTRA-UTERINE PREGNANCY. 46 1 

duced a metal ball electrode into the rectum, just beneath the 
tumor, and passed a current from a Kidder faradic battery 
through the tumor. The positive electrode was a broad 
sponge placed on the abdomen just over the tumor. The 
current was used for fifteen minutes, and was well borne by the 
patient. 

Electricity was employed in this manner each day for five 
days. 

September 26th, the day after the first application, the 
patient had no recurrence of severe pain, and felt relieved from 
the general abdominal pain. 

September 28th. She had a little pain. " But of a different 
character." 

September 29th. The facial expression has markedly 
changed, the anxious look has gone. 

October 2d. Dr. Thomas saw Mrs. S with me, and 

said the diagnosis was undoubtedly correct. 

I used electricity October ist, 4th, 9th and 13th. 

After the first application of the coil current there was no 
increase of size of the tumor, but I could not appreciate its 
decrease until October 20th, when it was markedly smaller. 

There was uterine discharge till October 20th, this was 
shreddy. It was not further examined. 

I report this case because it shows the efficiency of the fara- 
dic current in destroying the misplaced foetus, and arresting 
sac-growth. Many a physician has a battery, and skill in its 
use, who has not the ability to do a successful laparotomy. 

If the electrical current is effectual, it is without hazard to 
the mother, and in trying to do good it is most desirable not 
to do harm. 

At my last examination no remaining trace of the tumor 
could be detected. {Walker.) 



CHAPTER XXVII. 

OBSTETRICAL USES OF ELECTRIC CURRENTS. 

Pregnancy as a contia-indication for various electric currents. Uterine inertia 
in parturition. A clinical case illustrating three methods of faradic applica- 
tion. Indications for the faradic current during labor. Baird's method. 
Post-partum hemorrhage due to atonic state. Involution. Discussion on 
electricity in obstetric practice. Super-involution with amenorrhoea. The 
induction of premature labor. Post-puerpei-al metritis. Post-puerperal dis- 
charges. Phlegmasia alba dolens. 

Pregnancy as a Contra-Indication for Various Electric Cur- 
rents. — While much alarm has been expressed by theoretical 
writers over the dangers of employing electric currents during 
the pregnant state, yet all experienced operators become aware 
in the course of time of the fact that there is only a very 
remote liability of harm to the mother or the child, unless the 
application is deliberately made and the technique directed to 
the destruction of the foetus. 

Almost all the rational administrations of therapeutic cur- 
rents from improved apparatus are about as likely to be safe 
and beneficial to the sufferer during gestation as to the victim 
of disease who is not pregnant. 

During the first three months of pregnancy, apart from gen- 
eral applications, I regard the sedative-tonic effects of vaginal 
bipolar fine wire faradization as not only safe but beneficial 
and as good practice whenever indications for its use exist. 
No expert physician will be at all likely to produce harm by 
this method. It is extremely useful to allay nausea, reflex 
irritation and even the spasmodic contractions of a threatened 
miscarriage. 

About the year 1 860, Tripier of Paris introduced the bipolar 

electrode and vaginal bipolar faradization. Since that time 

462 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 463 

both the construction of electrodes and improved coils have 
increased the advantages and usefulness of this method. In- 
duction coil currents are also passed through the pregnant 
uterus by monopolar methods for various therapeutic purposes, 
and after an experience of great extent, covering a period from 
1859 to 1893, Tripier writes the following statement : " When 
I began these trials I adniitted with others that when a gravid 
uterus received faradization a miscarriage was brought on ; 
this is not so, however, as can be verified." 

Any local applications of the galvanic current either ex- 
ternal or vaginal in mild dosage and which do not invade the 
uterine cavity with an electrode may be safely made by any 
careful therapeutist. 

General faradization and central galvanization, including all 
ordinary external uses of these currents for local or general 
diseases outside the pelvis, and especially when applied for the 
relief of pain, may be considered safe practice. 

If they are employed with sufficient skill to do good in any 
ordinary case they will do about the same good during preg- 
nancy and are practically free from the liability of harm in 
the hands of any trained physician. 

It is a number of years since any writer of note has ventured 
to repeat the ancient superstition that electricity unfitted the 
uterus for pregnancy. The contrary is so indisputably the 
fact that ignorance itself has withdrawn the puerile charge of 
early days, but appreciation of the value of rational electro- 
therapeutics during the various indications of pregnancy re- 
mains to be developed among the profession at large. 

In the first three months of pregnancy I regard the sedative- 
tonic effects of static electricity as not contra-indicated in any 
reasonable form of administration which is necessary for the 
treatment of other conditions of the patient. 

All administrations of static, in the form of general electrifi- 
cation, breeze and spray, are safe and beneficial at all times 
during the entire course of pregnancy, whenever and wherever 
they are needed. They cause no muscular contraction, and 



464 OBSTETRICAL USES OF ELECTRIC CURRENTS. 

no untoward occurrence that might appear to be coincident 
could be attributed to them. 

Powerful sparks in the region of the pelvis would not be 
applied during any stage of pregnancy except for good cause, 
by one accustomed to every phase of static electricity, although 
as a matter of fact I have never seen them do any harm in any 
case, nor do I believe that it would be possible to produce a 
miscarriage by rational therapeutic measures with this agent. 
Sparks may be applied to the rheumatic joints, myalgia 
muscles, and neuralgic pains with the same good results and 
absence of harm that they are applied to non-pregnant women. 

Static electrification, positive or negative, and the positive 
breeze and spray, are not only as safe and beneficial as sleep 
itself when they are indicated in pregnant women, but more 
than any other sedative-tonic within the range of medicine a 
skilfully handled static machine will conduct them comfortably 
through the functional disturbances of gestation. 

The head breeze will remove for the time any headache that 
does not demand mechanical support to a dragging uterus for 
its relief. The mental states are comforted in the same way. 
The backaches are wholly removed as often as they recur by 
the spray and milk spark. Nausea often vanishes during gen- 
eral positive electrification and especially after a positive breeze 
over the region of the solar plexus. General nervous disturb- 
ances are controlled in the same manner, and for some time 
after such a treatment the patient feels like a new being. 

I have seen a woman in the third month of pregnancy step 
upon my static platform in such a state that it would be the 
despair of a medical prescriber to select a remedy that would 
enable her to become fairly comfortable without regard to 
time. In fifteen minutes she has spontaneously declared that 
she " felt made over new," had lost the nausea, repugnance at 
the mere thought of eating, severe lumbar pains, numbness in 
both upper and lower extremities, headache and depression in 
spirits, creeping chills, and has gone from the office directly to 
the dinner table and enjoyed a hearty meal. 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 465 

Such amelioration is not limited to a few moments after the 
treatment. It sometimes lasts but a day, while in other cases 
the patient continues to feel comfortable for one or two or 
more weeks. But after one experience with such an agent, with 
its demonstrated power to comfort her condition, she never 
again fails to turn to it for relief when occasion requires. 

If frequently administered during the latter part of gestation 
it will act as an efficient tonic and nutritional stimulant, and 
aid in meeting the trials of parturition with unshattered nervous 
forces and unimpaired muscular strength. 

In relieving the pains, discomforts and conditions which 
interfere with nutrition and sleep in the last month of pregnancy 
the static machine does for a suffering woman what nothing 
else can do to tide her over the crisis. 

It is well to say also that electrical tonic sedation often so 
far outclasses the effects of bromides, and other hypnotics, 
anodynes and sedatives as to displace entirely their routine 
use in the practice of the owner of a static machine, to the un- 
speakable benefit of his patients. 

Uterine Inertia in Paturition. — Employment of elec- 
tricity for this purpose should usually be preceded by dilata- 
tion of the cervix. Until the cervix is either dilating or di- 
lated, electrical apphcations are only indicated for sedative 
tonic effects. 

After this preparatory step moisten a felt or sponge covered, 




Fig. 185. Fine felt or sponge covered electrode. 

flat electrode in hot water, place it under the lumbo-sacral 
spine, and connect it with the positive pole of the induction 
coil apparatus. Connect the negative pole with an ordinary 
3 



466 OBSTETRICAL USES OF ELECTRIC CURRENTS. 

sponge-covered hand electrode about three inches in diameter. 
Moisten this in hot water, and lubricate it with a little soap. 




Fig. 186. Sponge-covered flat electrode. 

Switch into circuit the rapid vibrator, the total length of 
Nos. 32 and 21 wire coils, and with the negative electrode upon 
the abdomen over the fundus of the uterus increase the cur- 
rent strength until a mild stimulation is effected. Promenade 
the hand electrode slowly over the different portions of the 
fundus until regular contractions occur, and then only during 
contractions. Increase the current strength until it is suffi- 
ciently vigorous, and yet not uncomfortable to the patient. 
Intermit the applications so that they are made to follow as 
nearly as possible the normal action of the uterus. 

The management of the application must be governed by 
the progress made, and if effective stimulation sets up adequate 
natural contractions, the use of the current may be modified 
or suspended. 

The following single case illustrates the results of three dif- 
ferent methods of application : 

Mrs. S , mother of six children, had been having pains 

for twelve hours. Os soft and dilated, two inches in diameter, 
pains feeble. Finally, despite medical measures, the pains 
stopped and started again for three nights in succession, 
wearing the patient out, without result. A medium secondary 
induction coil current was then selected, an electrode placed 
upon each side of the fundus externally, and sufficient current 
strength employed to cause contractions of the upper seg- 
ment. This, however, did not push down the head. 



OBSTETRICAL USES OF ELECTRIC CURRENTS. . 467 

A Vaginal electrode was next placed internally against the 
ceJrvix, while the other electrode was held upon the fundus ex- 
ternally without success. 

A third trial was made, placing both electrodes externally 
with the positive under the sacrum, and the negative on the 
fundus. Passing the current directly through the pelvis in 
this manner, effectually aroused the uterus, and contraction 
became frequent and strong. During a ten-minute application 
the Os dilated rapidly. Labor was completed in less than one 
hour after the first application of the current. {Hyatt!) 



In the hands of those who speak from successful experience 
the sedative or sedative-tonic and stimulating variations of 
coil current applications during the different stages of labor 
subserve the following purposes : 

To modify the pains of labor. 

To favor a more rapid dilatation of the Os. 

To promote more vigorous uterine contractions. 

To add tone and strength to all the muscles engaged, and 
increase their power of doing work. 

To abridge the time occupied by the labor. 

To prevent shock, exhaustion, and post-partum hemorrhage. 

To insure contractions of the uterus in cases of instrumental 
delivery. 

To arrest hemorrhage and accelerate labor in cases of pla- 
centa prsevia. 

To prevent an undue expenditure of nervous force in all 
cases of debility from whatever cause, thus leaving the patient 
in a condition to secure a speedy and favorable convalescence. 
{Baird^ 

From a personal experience in the employment of an induc- 
tion coil current in 220 cases, Baird has the following to say 
about rhethods of application. The chief are : 

1. One electrode in the vagina and the other over the 
fundus.- 

2. Both electrodes externally over the abdominal parieles. 

3. One electrode on the sacrum and the other on the ab- 
dominal parietes. 



468 



OBSTETRICAL USE OF ELECTRIC CURRENTS. 



The above, and other methods found successful by 
various writers, all include the uterus and its nerves within the 
circuit. Method No. i (adopted by former writers) is open to 
the great objection that in some cases it will bring the elec- 
trode in too close proximity to the head of the child. Never 
make the application in such a manner as to include the head 
of the foetus in the circuit in any case where its welfare is to 
be considered. 

No. 3 is a very safe and effective manner, as I can testify 
from its use in over two hundred and twenty cases, but if 
I should ever encounter a case in which this method failed 
I should then adopt method No. 2. 

Playfair says; "Uterine manual pressure is the best and 
safest oxytocic." I consider it an improvement on Playfair's 
measure to have the hand that makes it form one electrode of 
a good and reliable induction apparatus. The same manipu- 
lation and the same pressure can be made with it as though 
it was unconnected with the apparatus. In cases of uterine 
inertia I have never failed to quickly excite vigorous uterine 
contraction by this method, and often with refreshing and 
restorative effects upon the patient. 

As soon as I deem it necessary to make the application I 




Fig. 187. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 




Fig. 188. Self-retaining wrist electrode. 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 469 

do so in the following manner: Place the patient in the 
dorsal position. Moisten a felt or sponge covered, flat elec- 
trode, three inches wide and six inches long, connect it with 
the positive pole of an improved induction coil apparatus 
and place it under the lumbo-sacral spine in the direction of 
its axis. Connect the negative cord to a wrist electrode and 
apply it to one of the wrists, moisten the hand with warm 
water and apply it to the abdominal parietes. Switch into 
circuit the rapid vibrator and the combined primary and short 
wire secondary coil. Do not begin with a strong current, 
but gradually increase the dosage until it has a pleasant and 
soothing effect upon the patient, or is as strong as the oper- 
ator's hand will bear. 

Make the application with the hand continuous until a 
sufficient amount of sedation is produced (from five to thirty 
minutes), then remove the hand during the interval between 
pains and manipulate the uterus again when the pain recurs. 
After all reflex pain has been subdued and the patient rests 
well in the intervals, only keep the circuit closed during the 
time occupied by the rhythmical contractions of the uterus. 

By this means I am able to determine the exact condition 
of the uterus and to note correctly all the changes which 
may occur in its contour, and I can also estimate the amount 
of increase which occurs in its contractions, and I am also 
enabled to perform uterine manual pressure, and if it is 
necessary to use both hands for this purpose it can readily 
be done, and each hand then conveys the current to or from 
the uterine walls. 

By an intermittent application we are effectually guarded 
against the danger of destroying the electro-muscular con- 
tractility of the organ which we wish to stimulate and 
strengthen. I have used it in this manner in tedious labor 
for twenty-four hours and during all this time it furnished 
to the nerves and muscles all the elements of increased 
strength and rest, as was fully evinced by the ability of the 
patient to withstand her pains, and by her earnest desire, 
often reiterated, " not to allow her to have a pain without 
closing the circuit." 

With each recurring pain change the location of the elec- 
trode so that all the muscles engaged may be brought 
directly under the influence of the current. 

As soon as I wish to facilitate the labor at the beginning 
of the second stage I use a current of as much force as the 
patient can bear with comfort, and in practice it will be 
found that the stronger the current used in this stage, short 
of producing spasmodic contractions of the abdominal muscles, 
the better it will suit the feelings of the patient. 



470 OBSTETRICAL USES OF ELECTRIC CURRENTS. 

After the perineum is well dilated, I moderate the force of 
the current, and in cases where I have any reason to appre- 
hend danger to the integrity of this structure I withhold it 
entirely for a few minutes prior to the escape of the foetal 
head from the vulva, so as not to hasten unduly the labor 
at this stage, and to give ample time for its full, free and 
safe dilatation. 

As soon, however, as the head, escapes, I direct the circuit 
to be closed most of the time until after the completion of 
the third stage of the labor, which in nearly all cases occurs 
with but little or more assistance in a very few minutes. 

In all of my cases in which I have used it, the placenta has 
been expelled in from one to ten minutes from the birth of 
the child, with very slight or no traction upon the cord. This 
I regard as more simple, far less painful, and fully as speedy 
and efficient as Prof. Crede's method. 

Baird collected the entire bibliography of this subject and 
formulated the indications. He concludes his own import- 
ant contribution to the American Journal of Obstetrics, in the 
following manner : 

" It only remains for me to say that as an exytocic, to pro- 
mote uterine contraction and facilitate labor in all its stages, 
all that has been quoted from our best writers in its favor is 
true. When I say that upon my approach to the bedside of 
my patient and have found the Os dilated barely enough to 
admit the point of my index finger, that I then make an appli- 
cation of the faradic current, and that it promotes contractions 
of the longitudinal and oblique muscular fibres of the uterus, 
thereby rapidly dilating the Os ; that in one hour the second 
stage of labor is ushered in, and that in thirty minutes more 
the third stage had been completed — and I adhere to the 
statement that the rapidity of the course of labor was due to 
the measures adopted — this reflection consoles me, namely: 
That if my reader will attach any importance to my state- 
ments, and will faithfully follow in my footsteps, he will cheer- 
fully sustain me in all that I have claimed. 

I am fully aware of the fact that any physician who has 
enjoyed even a moderate amount of obstetric practice can 
readily refer to cases in which he has observed the same happy 
results, in which no measures were adopted to facilitate the 
progress of the labor ; and I am also aware of the further fact 
that he can with equal readiness refer to a far greater number 
of cases in which he would, at the time in which they were in 
progress, have cheerfully been willing to have made almost any 



OBSTETRICAL USE OF ELECTRIC CURRENTS. 47I 

personal sacrifice for the use of a reliable oxytocic ; one which 
would have rendered him service at any stage of the labor. 
When his patient suffered from pains not only ineffectual, but 
rapidly exhausting' her nervous forces'; when her increasing 
anxiety and distress acted like a contagion upon the friends of 
the household ; when precious time hung heavily upon his 
hands, and he was unwillingly compelled to witness sufferings 
which he had no power to control or abate; when from his 
ripened experience he kiiciv that this undesirable condition 
of affairs would not only continue for an indefinite number of 
hours, but tvas certain to grozv tvorse ; when every recognized 
measure had been faithfully carried out ; when there was noth- 
ing left for him to do but to apply ' uterine manual pressure,' 
as the safest and best oxytocic, at the risk of impressing her 
with a deep conviction that her condition was full of peril — 
what would he then have given if the hand with which such a 
pressure was made formed one electrode of a good, reliable 
induction apparatus, especially if the vitalizing current from 
it furnished a sedative force to every sentient nerve involved, 
a stimulating force to every motor nerve, and to every muscu- 
lar fibre engaged? If this new force, this sensible increase of 
power, gratefully recognized as such by the patient, soothed 
her pain, refreshed her muscles, restored her strength and 
waning confidence, would not the physician, from the very 
depths of a thankful heart, have been ready and willing to 
exclaim :. ' Electricity stands unrivalled as an exytocic' ? " 
{Baird.) 

Post-partum Hemorrhage due to Atonic State. — In a case 
of this kind intra-uterine interference may be wisely reserved 
and the routine recommendations of obstetrical text books 
may be considered subordinate to the prompt and simpler 
action of electric currents. 

I. Place an ordinary sponge or felt covered, flat electrode, 




Fig. 189. Sponge-covered flat electrode. 



472 OBSTETRICAL USES OE ELECTRIC CURRENTS. 

about the size of the palm of the hand, beneath the sacrum 
and connect it with the positive pole of the portable induction 
coil apparatus which every obstetrician should consider as 
much a part of his equipment as a pair of forceps. Connect 
with the negative pole a sponge-covered hand electrode and pro- 
menade it slowly over every portion of the abdomen over the 
fundus making firm pressure down upon the uterus. Both 



Fig. I go. Sponge-covered hand electroue. 

electrodes should be moistened with hot water and the hand 
electrode lubricated by rubbing it two or three times over 
a cake of toilet soap. 

Employ the rapidly interrupted current from the combined 
No. 32 and No. 21 wire secondary coils and quickly increase 
the current strength from zero until it produces effective con- 
tractions, which should, however, be without discomfort to the 
patient. If the uterus does not at once respond, scarcely a 
moment need be lost before employing the next and more 
active method. 

2. A large intra-uterine bipolar electrode with a long hard 
rubber insulating handle should also always be carried. In 
any rare and desperate case in which the foregoing method is 
not effective instantly transfer the conducting cords to the 
bipolar electrode, sterilize this and instantly insert into the 
uterus to the fundus. Quickly increase the current from zero 
until it contracts down the uterus. Owing to the liability of 
carrying external infection into the uterus this method should 
be reserved until it is rendered necessary by the failure of the 
external application, which is always safe. 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 473 

The " hot douche, ice in the vagina or uterus itself, astrin- 
gent preparations and vinegar, flagellation with a cold wet 
towel," are time-honored remedies which engage the close 
attention of the student in every medical college. In practice 
the coil current outvalues them all. It is the hemorrhage of 
atonic vessels from over-distension, anaemia, collapse, or any 
form of muscular atony which contractions arrest, and bleed- 
ing due to lacerations of the cervix do not come under this 
category. 

If any portion of the placenta is retained to keep open the 
mouth of a bleeding vessel it is obvious that prompt removal 
must precede success with the coil current. 

Speaking from the experience of forty-one years Nunn 
recently said : 

" In atonic post-partum hemorrhage the effect of the applica- 
tion of the current is magical, and the control of the bleeding 
is rapid, complete and absolute." 

See also Chapter No. XVII. on menstrual derangements 
(Bleeding States of the Uterus) for further experience 
with faradic currents in hemorrhage. 

The greatest sphere of usefulness of electricity in obstetrics, 
it seems to me, is after the close of the.third stage of labor, after 
the uterus is empty, where atony exists, and where we are 
afraid we shall have post-partum hemorrhage. I think the 
greatest and highest use to which we can put electricity in our 
practice is in those cases known as subinvolution following a 
bad getting-up from confinement, where the uterus is .flabby 
and soft and bleeds easily and is apt to get displaced. There 
I think is where electricity comes in and will often produce 
marvellous results. From such experience as I have had I am 
exceedingly well satisfied in regard to the benefits that accrue 
from electricity in this class of cases. I am sure that I am 
able to get the most salutary effect upon the lining membrane 
of the uterus, and also promote absorption and diminution in 
the size of the uterus b^- employing a bipolar faradic current 
of high tension. The ligaments strengthen and in every way 
the results are all that could be desired. (Danforth!) 

Involution. — Faradic. — The tendency of patients to " get up 



474 OBSTETRICAL USES OF ELECTRIC CURRENTS. 

too soon " after confinement retards the process of involution 
and makes chronic invalids out of women who would other- 
wise be well. The process of involution can be aided by the 
attendant physician during the time the patient remains in 
bed by daily applications of an induction coil current. Intra- 
pelvic interference is not desirable, and the electrode should be 
applied externally. 

Place a felt-covered, flat electrode, 4X6, under the sacrum 
and connect it with the positive pole of <-he portable high- 




Fig. 191.- Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

tension induction coil apparatus. Press a negative sponge- 
covered hand electrode firmly upon the lower abdomen over the 
fundus of the uterus. Make deep pressure while the patient 




Fig. 192. Sponge-covered Hand electrode. 

lets out her breath until the electrode is in position and 
retain it in close contact. 

Switch into circuit the No. 21 and No. 32 secondary coils, 
the rapid vibrator and four cells. Increase the current strength 
from zero until it maintains a strong contraction of the parts 
for ten minutes. 

This simple but useful application can be employed in all 
cases which appear to require help or which progress slowly, 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 475 

and in atonic cases the benefit will be marked. Even after 
the patient is up and about the applications can often wisely 
be continued three or four times a week for a fortnight longer, 
when, if necessary, the bipolar method can be used. The 
vaginal bipolar electrode may be employed as soon as the 
second week after delivery. The intra-uterine bipolar should 
not be used until the safer methods have completed their work, 
and only when the liability of sepsis is reduced to nil. 

Diseussion on Electricity in Obstetric Practice. — The fol- 
lowing extracts from a discussion (September 1896) upon the 
value of a portable coil apparatus in obstetric practice will be 
suggestive to the general practitioner : 

Dr. Nunn. To the obstetrician the faradic current is ordi- 
narily used with a view to hastening processes delays in which 
involve danger to the patient. Such for example is the case in 
the electrical treatment of post-partum hemorrhage resulting 
from inertia which may be distinguished as atonic as opposed 
to that resulting from a physical lesion. 

An application of the principles upon which the electrical 
control of post-partum hemorrhage is founded to the treatment 
of involution offers a fair prospect of benefiting the parous 
woman by reducing to a minimum the number of the days of 
her lying up, and lessening if not altogether suppressing the 
diseases consequent upon subinvolution and the persistence of 
a relaxed condition of the pelvic tissues. In cases having the 
characteristic want of tone, the lack of spring, the inability to 
recover from a disturbance either because the nerve power is 
wanting or the muscles will not respond, the faradic current 
will prove of the greatest service, and by its judicious use and 
the simultaneous employment of careful asepsis and the proper 
support it is possible to avoid entirely the usual lying up after 
confinement. 

In a crucial test of these views in one case in practice (that 
of a multipara) the result was highly satisfactory, the patient 
remaining in bed but twenty-four hours after confinement and 
experiencing no suffering or inconvenience other than renew- 
ing a dressing twice daily for a few weeks, then gradually 
discontinued. In this case not only was there no suffering 
but the treatment proved to be most beneficial, as it resulted 
in the cure of a prolapsus which the patient had inherited 
from a previous confinement. 

Dr. Morse. I have had some experience in using the faradic 



476 OBSTETRICAL USES OF ELECTRIC CURRENTS. 

current in ordinary cases of tedious labor and nearly always 
find it an aid in saving time and inducing powerful contrac- 
tions of the uterus. The patients say that they can bear the 
pain better. It facilitates the labor all around. I arise to 
speak particularly of a case of subinvolution I had five or six 
days after confinement. The uterus was large, soft and bleed- 
ing. I tried various remedies without any result at all. 

I applied the galvanic current, loo milliamperes, with the 
positive pole in the uterus and the hemorrhage stopped almost 
immediately. 

I then used the faradic current, one pole in the uterus and 
the other alternately over the sacrum and over the fundus, and 
the result was very marked. 

For the last three or four years I have always carried a 
portable battery with me to save time and to save sleep. The 
patients I have used it with once and to whom I have gone a 
second time have always asked for it, saying that it gave them 
much relief. 

Dr. Smith. I know a good many physicians who carry a 
small faradic apparatus together with their obstetric bag, and 
men have told me they believed they had saved more than one 
life by having it along, especially in cases of post-partum 
hemorrhage. I believe it is a means of arresting post-partum 
hemorrhage and also of helping uterine contractions when they 
are not sufficiently powerful. Of course quinine and ergot are 
other means, but the application of the faradic current to the 
abdominal wall is very simple and safe, and very speedy in 
increasing uterine contractions. 

Dr. Dame. In addition to the use of the faradic current in 
post-partum hemorrhage I have used it in menorrhagia from 
atonicity. In many cases of excessive menstruation this 
treatment gives very satisfactory results. Subinvolution from 
any cause will readily yield to it. I have found it very useful. 

Dr. Morse. I have a patient whom I have attended in three 
different confinements. On two occasions I have used the 
faradic current and she did not have any after pains at all. I 
have in mind several cases where I have used it previous to 
birth to produce more forcible contractions and did not have 
to use the customary remedies for after pains. 

Dr. Smith. I can quite understand that. The after pains 
are supposed to be due to the presence of a clot in the uterus. 
Now we do not get a clot in the uterus when the contractions 
are good. It is when the contractions are not good that the 
hemorrhage takes place in the uterus and this excites the after 
pains to expel the clot. I can understand that when you use 
the coil current that you will get such good contractions right 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 477 

after labor that there will be ho hemorrhage and no clot to 
expel. 

I wish also to report only the most favorable results from 
the use of post-partum bipolar faradization. It insures both 
vaginal and uterine involution promptly. I do not use it 
until the second or third week. {Love.) 

" At an adjourned meeting of the Paris Academy of Medicine, 
Dr. Apostoli read a communication on the above subject. 
He remarked that at present histology and clinical observation 
agree in attributing almost all cases of metritis and uterine 
engorgement to interrupted uterine involution. He, there- 
fore, proposes as a prophylactic agent in an affection which so 
often follows labor the adoption of the following new thera- 
peutic method. He thus expresses himself : A woman having 
been delivered, whether at full term or not, I immediately 
apply to her uterus a faradic or induction current generated 
from a coil made from a short thick wire, and of progressive 
intensity. 

" In case of normal and full term labor, I renew this applica- 
tion eight or ten times within about six days. In case of 
difficult or premature labor, I repeat it fifteen or twenty times 
through a period of from ten to fifteen days. My object is to 
aid, hasten and perfect uterine involution, and thus avoid all 
the complications incident to slow or deferred convalescence. 

" I propose the introduction in obstetrical therapeutics of 
uterine faradization in every case of labor : First, because it is 
a wonderful method, of easy application, readily controlled, 
rapid and energetic in its effects, always harmless and capable 
of being applied or discontinued at will ; and second, because 
its immediate effects tend to restore the patient's health, 
while it ultimately guards against all subsequent uterine 
complications." 

Superinvolutionwith Amenorrhoea. — Faradic. — This condi- 
tion may be treated upon the same principle as amenorrhcea 
with an undeveloped uterus. The essential circulatory, mus- 
cular and nutritional stimulation is effected by the faradic 
current. 

Place a flat sponge-covered electrode upon the back of the 
neck and connect it with the positive pole of an improved 
high-tension coil induction apparatus. Insert a sterilized 



478 



EBSTETRlCAL USES OF ELECTRIC CURAENTS. 




POSITIVE. 



Fig. 193. Sponge-covered flat electrode. 

electrode sound to the fundus of the uterus and switch four 
cells, the rapid vibrator and the 1,500-yard No. 36 coil into 



Fig. 194. Intra-uterine electrodes. 

circuit. Gradually increase the current strength from zero 
until the tolerance of the tissues is determined and continue 
the treatment with the particular coil which furnishes the nec- 
essary dose. Length of sitting may be fifteen minutes at 
first, if sedation is required to allay any local tenderness, but 
when more active stimulation is tolerated the time may be 
reduced to ten minutes. Repeat three times a week. 

The applications may be made daily about the time that 
the flow should appear, as indicated by the symptoms of the 
patient. >" 

When the periods are established the treatment should con- 
tinue for several months with more or less regularity, and if 
the flow is not free after the nutrition of the muscular body of 
the uterus has been restored a few intra-uterine applications of 
a negative galvanic current, 20 mil., may be employed to 
stimulate the secretory function. 

The Induction of Premature Labor. — Employment of 
electricity for this purpose should be preceded by local dilata- 
tion of the cervix by ordinary methods. Until the cervix is 



OBSTETOICAL USES OF ELECTRIC CURRENTS. 479 

either dilating or dilated, electrical contractions are not in- 
dicated. The methods to follow are the same employed in 
normal labor, and fully discussed in previous pages. 

There is one point that the speaker did not mention that 
served me in a very trying case, and that is the induction of 
premature labor. I had a case this past winter — a lady who 
on previous occasions of confinement had been seized with 
very violent post-partum convulsions, due to uraemia. 

The pregnancy was advised against, but the advice not 
taken. She presented herself later, pregnant, iwith all this terror 
ahead of her. A few of my friends were asked to consult with 
me concerning it, and we decided that we ought to produce an 
abortion. She had had five very strong convulsions, and 
nearly lost her life. We discussed the various means, and 
finally decided to use electricity. . We u.sed the induced faradic 
current. The application was made for one hour, one pole in 
the vagina applied to the cervix, the other over the abdomen. 

There was little or no pain at the time, although there were 
some contractions of the abdominal muscles; but one hour 
afterward she had a slight show, and during that night or early 
the next morning labor set in quite actively, and she was re- 
lieved with very little trouble. The advantage to her seemed 
to be the avoidance of the risk of irritation and infiltration. 

I know of one or two other similar cases where it was also 
used, although not in my hands, with equal success. ( Young- 
man.) 

Post-puerperal Metritis. — Whether involution is arrested 
by mere inertia or some form of infection it is certain that the 
process should not be allowed to become chronic. Recent 
subinvolution can be more successfully and quickly treated 
by an induction coil current than by any other means at our 
command. 

First employ vaginal bipolar faradic sedation, and gradually 
merge this into tonic, and finally into stimulating applications 




Fig. 195. A proper bipolar electrode. 

as fast as the improvement increases tolerance. Daily sittings 
for a week are advisable, and treatment three times a week 



48o 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 



should be continued until benefit is sufficient ; or if more 
direct contraction of the muscular fibres is required during the 
latter portion of treatment, moisten a felt-covered, flat elec- 
trode, 5X7, connect it with the positive pole of the induction 




Fig. 196. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating baclcs. 

coil apparatus, and place it upon the sacrum and lower abdo- 
men in alternate sittings. Sterilize an ordinary intra-uterine 






jl^jHOQ 




Fig. 197. Intra-uterine electrode — assorted size tips. 



sound electrode, connect it with the negative pole, and insert 
it into the uterus. 

Switch the rapid vibrator and three or four cells into circuit. 
Commencing at zero gradually increase the current strength 
from the coil which a moment's test determines to be adapted 
to the tolerance of the tissues. After maintaining the con- 
stantly even current for five^ininutes, produce strong contrac- 
tions of the body of the uterus by either the slow vibrator, or 
by momentarily decreasing the resistance in the rheostat so 
that the current is increased suddenly, and as suddenly reduced 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 



481 



to the ordinary dosage. By this undulating niethod the max- 
imum impulses produce very effective contractions. 

The use of an intra-uterine bipolar electrode in these condi- 
tions is not very necessary nor very advisable, although it is 
recommended by some. It should only be employed by a 
practised operator and with special care. 

Post-puerperal Discharges. — Sanguineous discharges con- 
tinuing beyond the normal periods of their appearances, or re- 
turning during the first weeks after parturition, may be con- 
trolled in the following manner : 

Moisten a felt-covered, flat electrode, about 5x7, in hot water, 




Fig. igS. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

connect it with the negative pole of the high-tension induction 
coil apparatus, and place it either under the sacrum or upon 
the abdomen. Sterilize an intra-uterine electrode-sound in 
the alcohol flame, connect it with the positive pole, and insert 



^^^B^am 




Fig. 199. Intra-uterine electrode — assorted size tips. 



it with extreme gentleness into the uterine cavity. In these 
cases an antiseptic vaginal douche is a wise precaution. 

Switch into circuit the rapid vibrator, about four cells and 
the 1,500 yard No. 36 coil. Gradually increase the current 
strength through the rheostat from zero until the proper coil 
31 



482 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 



is selected, and the dose regulated so as to cause comfortable 
but strong contractions of the muscular fibre of the uterus. 
Maintain the current strength at the point of comfortable tol- 
erance for about eight minutes. Gradually reduce to zero, 
and withdraw the electrode. 

Repeat two or three times, as maybe necessary, and if tTiere 
has been no septic infection or injury to complicate the case, 
no other treatment will be required. 

Phlegmasia Alba Dolens. — Moisten in hot water a flat 
sponge-covered electrode about the size of the palm of the 
hand, and for convenience, if the patient is recumbent in bed, 
place it under the sacrum where the weight of the body will 




Fig. 200. Sponge-covered flat electrode. 

keep it in firm contact. Connect this electrode with the nega- 
tive pole of the high-tension induction coil apparatus. 
Moisten a medium-sized, sponge-covered hand electrode, 
ubricate it by rubbing it several times over a cake of toilet 
soap and connect it with the positive pole. 

Switch into circuit the three secondary coils combining 500 




Fig. 201. Sponge-covered hand electrode. 



OBSTETRICAL USES OF ELECTRIC CURRENTS. 483 

yards of No. 36 wire with 800 yards of No. 32 wire. Adjust 
the rapid vibrator to very rapid andsmooth action and employ 
three or four cells. 

Place the hand electrode upoii the anterior surface of the 
thigh and gradually increase the current through the rheostat 
from zero until it causes a perceptible and agreeable sedative 
grasp upon the tissues. After regulating the dose promenade 
the positive elec-trode over the entire limb from the hip down 
avoiding the sensitive parts of bony prominences about the 
joints and situations which do not require treatment. Fifteen 
minutes of this application will produce several hours of 
comfort. Repeat twice a day during acute stage and lengthen 
the intervals as improvement progresses. 

Attention to the usual methods of treatment, action of the 
bowels, etc., is of course understood. The effect of the faradic 
sedation is both palliative and curative. If the limb is causing 
the patient great suffering the value of faradic sedation will be 
appreciated. 



la mm. 



CHAPTER XXVIII. 

TREATMENT OF VOMITING OF PREGNANCY, OR REFLEX 

IRRITATION. 

Vomiting of Pregnancy or Reflex Irritation. — Both nausea 
and the tendency to hyperemesis in the early stages of preg- 
nancy have been removed by simple static electrification to 
which I have sometimes added a sedative breeze over the 
region of the solar plexus. I have observed these ameliora- 
tions in patients who were neither taking any medicine nor 
being treated for hyperemesis. The fact that they were thus 
relieved has been reported to me after they had observed it 
with surprise. It is doubtful if this method would be effective 
in any aggravated case. 

Vaginal bipolar faradic sedation for twenty minutes repeated 
daily has given relief in cases more obstinate. I have never 
observed any ill effects from this application, and my belief 
that it is devoid of danger in the hands of any physician who is 
competent to regulate the dose is supported by the statement 
of Tripier : " When I began these trials (treatment of uterine 
displacements) I admitted with others that when a gravid 
uterus received faradization a miscarriage was brought on. 
This is not so however, as can be verified." 

In a more obstinate case there are several variations of meth- 
od with both galvanic and induction coil currents which may 
be tested, and the one which affords the most relief employed. 

Chief Method. — Seat the patient upon a chair with the 
clothing loosened about the neck and the abdomen. Connect 
two small electrodes about an inch in diameter with the posi- 
tive pole of the galvanic battery by a bifurcated cord, moisten 
the covering with a hot-water two per cent, solution of bicar- 
bonate of soda and press them upon the right and left pneu- 

484 



TREATMENT OF VOMITING OF PREGNANCY. 



485 




Fig. 202. Ordinary sponge-covered hand electrode. 



mogastric on each side of the neck, above the clavicle and 
between the insertions of the sterno-cleido-mastoid. 

Moisten a felt or sponge covered flat electrode, about 4X6, 
in the same bicarbonate of soda solution, connect it with the 





Fig. 203. Fine felt or sponge covered electrodes — assorted sizes with soft rubber 

insulating backs. 

negative pole and have it pressed over the epigastrium. 
Gradually increase the constant galvanic current through a 
rheostat from zero up to the efficacious dosage, which must be 
determined during each treatment. It may be usually 8 or 10 
mil., but may be less and may require more. 

Continue the application until relief is secured whether it 
takes fifteen or twenty minutes, or even more. In severe cases 
repeat after each attack or several times daily. As it often 
happens that food qan be retained during the passage of the 
current which would be otherwise rejected it is good prac- 
tice to administer the application immediately after eating 
when this is feasible. Valuable suggestions will be obtained 
by the reader who examines carefully the cases of Gautier and 
the remarks of Apostoli which are incorporated in this section. 



486 



TREATMENT OF VOMITING OF PREGNANCY. 



Faradic. — Place a felt or sponge covered flat electrode about 
the size of the palm over the epigastrium and connect it v/ith 
the positive pole of the high-tension induction coil apparatus. 
Place a similar electrode directly opposite on the back and 
connect it with the negative pole. Moisten both electrodes in 
the hot solution of soda-bicarbonate. For convenience the 
patient should recline in the dorsal position. The weight of 




Fig. 204. Fine felt or sponge covered flat electrodes — assorted sizes with soft 
rubber insulating backs. 

the body will then make firm contact with the negative elec- 
trode, and the positive electrode may be kept in place by 
either a small shot bag or the weight of the patient's hand. 

Switch into circuit the rapid vibrator, three or four cells, 
and begin with the 1,000 yard No. 36 coil. Gradually increase 
the current strength by means of the rheostat from zero until 
it produces a strong but comfortable grasp upon the tissues. 
If the first coil selected does not produce sufficient current 
with the full E. M. F. of four cells, switch 800 yards of No. 32 
coil into circuit and regulate the dose until the effect is pro- 
duced. It will be borne in mind, as fully explained elsewhere, 
that the variety of coils affords the means of adjusting dosage 
to produce desired effects. 

By the aid of one of these methods, in addition to regulation 
of the bowels, relief of constipation, and attention to the func- 
tions of the liver, there will be few cases in which the physician 



TREATMENT OF VOMITING OF PREGNANCY. 487 

will fail to obtain satisfactory results. The last method de- 
scribed is sometimes one of the most effective means to allay 
gastric irritability. 

Drs. Gautier and Larat at quite a recent date have made an 
elaborate report upon the electrical treatment of nervous vom- 
iting, from which the following is selected for the benefit of 
readers to whom the subject may be important. 

Various treatments have been suggested for intractable 
nervous emesis, and in the long list of therapeutic procedures 
recommended, Pinard says that nothing can be prescribed to- 
day except with the idea that it may succeed. We believe 
that electricity is one of the most powerful remedies, if the 
methods and precautions are followed, which we use, and 
which were described by Semolla seventeen years ago. He 
has systematically electrified all his cases of intractable emesis, 
both hospital and private, and considers this treatment so in- 
fallible that he uses it for. diagnostic purposes. The cessation 
is, he considers, proof of symptomatic vomiting, whether the 
organic lesion be in the stomach or elsewhere. In support of 
this theory he has published some very remarkable and con- 
stant results. Others have used a variety of methods with 
both galvanic and faradic currents, but their results have not 
been as constant or as rapid as those of Semolla, and we agree 
with him in thinking that galvanism, except perhaps in cases 
of hysterical vomiting, is infinitely preferable. 

In all of our cases the vomiting has been stopped at the end 
of forty-eight hours, or at least decidedly ameliorated. The 
number of daily treatments, their duration and dosage can be 
given but approximately. In the following cases we give only 
those which have been followed by hospital physicians. Re- 
cently we have had the pleasure of successfully attending a 
case of vomiting in the wife of one of our confreres, which had 
been treated by all the usual methods without result. 

Case I. Mrs. K , primipara ; good health ; menstruated 

regularly. Menses stopped January 8, 1895 ; vomiting com- 
menced February 22. The patient could retain nothing, and 
vomited forty-five times in twenty-four hours, having violent 
epigastric pain and frequent fainting attacks. The second week 
the nights became bad, the pulse filiform. She then became pale 
and began to lose weight. Finally, an obstinate constipation 
was added. The vomiting became worse, and the insomnia 
was complete, with great physical prostration and cerebral ex- 
citement. Drugs had no effect. 



488 TREATMENT OF VOMITING OF PREGNANCY. 

Professor Dieulefoy advised increased doses of morphine, 
and, if these proved ineffective, the induction of abortion. 

The case had lasted thirty-six days, and there v^^as danger of 
death from inanition, when Dr. Champetier de Ribes, called in 
on March 25, advised electricity. The treatment was com- 
menced that evening. 

The patient was able to retain half a cup of milk, and felt 
better. About 3 A. M. she became worse again. The follow- 
ing day at 8.30 A. M. the treatment was repeated with the same 
results ; but the pain, when it returned, was violent. 

The third treatment was in the afternoon ; the fourth in the 
evening. A continuous improvement commenced, the nausea 
becoming less, the pulse better, the constipation disappearing, 
while on the third day she slept without morphine. These 
treatments were given thrice daily for three days; then twice 
for five days. The patient could eat anything. The eighth 
day the cure appeared complete, but the treatment was con- 
tinued once daily. On the sixteenth day she had regained her 
normal condition, and soon left Paris. 

Case II. Intractable vomiting and constipation of seventeen 
days' standing ; continuous and abundant salivation. Mrs. 
De R., set. forty ; multipara ; five sound children ; good health ; 
sixth pregnane)' in October, 1894. Vomiting appeared follow- 
ing December. The patient could retain no food. All medi- 
cation was vain. Morphine was given to induce sleep. Lavage 
was not tolerated. The sixteenth day the doctor (Dr. Champe- 
tier de Ribes) advised electricity. The patient at this time was 
pale and emaciated, complained of great fatigue with vertigo, a 
nervous erethism and insomnia, and had nausea day and night. 
She could retain only a little kirschwasser. Vomiting of bile ; no 
stool for seventeen days. December 17, 20 ma. galvanization 
of vagus for twenty minutes. The resistance was noticeable. 
This diminished in subsequent sittings. The treatment was 
well tolerated, and a cup of bouillon retained. There was 
some nausea during the night and vomiting in the morning. 

The morphine was stopped against the wish of the patient. 
December 18, two treatments, the — being at the level of the 
umbilicus, the + over the course of the vagus for fifteen min- 
utes, and over the back of the neck for the same length of 
time. Nourishment, with but one vomiting attack during the 
night. The constipation was first touched on the nineteenth 
day after faradism had been given. On December 26 the 
patient is much better, retains food, bowels move, though a 
little salivation remains. The sleep is good. Thereafter but 
one daily treatment, until February 3, when it was stopped 
entirely, the patient being cured. 



TREATMENT OF VOMITING OF PREGNANCY. 489 

Case III. Mrs. L. M , twenty-three years old ; married 

at twenty-two. In February, 1894, was troubled with vaginis- 
mus, which was ameliorated in six treatments with the alter- 
nating current. One pole was placed on the sacrum, the other 
in the vagina. 

First pregnancy in March, 1894. Nothing particular for 
three months. At the end of June, however, the vomiting be- 
gan, and was obstinate, in spite of lavage and medicaments. 
She could retain neither solid nor liquid food. 

July 7, descending galvanism to the vagus enabled her to 
retain a glass of water. On the 8th, after two treatments, a 
cup of bouillon, was retained. 

On the loth and nth, two treatments. Each is, stopped at 
the end of ten minutes ; the patient takes bouillon, and the 
treatment is resumed for five minutes. The sixteenth day the 
treatment was discontinued, and the accouchement in Decem- 
ber was normal. 

In this case a cup of bouillon caused distress for several 
hours, unless followed by the treatment. This is well illus- 
trated by Case No. VIII. 

Case IV. The patient imagined that the tingling sensation 
at the electrodes helped her; so she was put on the current of 
tension. As she did not improve, galvanism was resumed, 
effecting a cure. 

Case V. Extra-uterine pregnancy. The galvanism con- 
trolled the vomiting up to the time of the operation, and as- 
sisted in the convalescence. 

Case VI. Patient did not vomit during first pregnancy. In 
the second, drugs were of no avail, but the condition was re- 
lieved in forty-eight hours by galvanism. 

Case VII. In a case of three months' pregnancy the emesis 
had lasted several weeks, and invariably followed the taking of 
any food. Vomiting, which could not be helped by the usual 
methods, was cured by galvanism in four treatments. 

Case VIII. On April 3 a case was seen which was pale, 
weak, emaciated. A cup of bouillon was vomited five minutes 
later. After the treatment she was able to retain it ; in five 
days could eat meat, and in seven was completely cured, and 
remained so. 

Case IX. (Dr. Fourrier.) Two months' pregnancy ; anorexia, 
nausea, emaciation, and prostration. Medication vain; the 
electric treatment rapid and complete. 

Case X. A little girl of eleven had nervous vomiting. Diag- 
nosis uncertain ; possibly hysteria, possibly uraemia (there 
were traces of albumen in the urine). Her condition was 
somewhat amehorated, but she finally died. 



490 TREATMENT OF VOMITING OF PREGNANCY. 

Case XI. Mrs. G., set. thirty ; had typhoid when seventeen, 
but made a good recovery ; married at twenty-two ; no chii- 
dren. Three years later she had a painful spot over the left 
eye and attacks of vomiting, having no apparent relation to 
her diet. This stopped after an external application of cam- 
phor and alcohol, with the exhibition of quinine. A year later 
the condition returned. The nausea persisted as long as the 
head pained. Still later she discovered that she was nearly 
blind in the right eye. An atrophy of the retina was diag- 
nosed. ' Being treated by the method as above, she gained 
.strength. Finally the other eye was affected ; but, notwith- 
standing an undoubted cerebral lesion, the current controlled 
the vomiting, and, though nearly blind, she grew stout. 

From these observations we draw the following conclusions: 
(i) Descending galvanism over the course of the vagus, fol- 
lowing the above method (long, small current, with frequent 
sittings), is a valuable treatment for vomiting. 

(2) It is a curative remedy of the greatest value in the vom- 
iting of pregnancy. 

(3) In nausea due to grave, or even lethal, lesions of the 
nerve centres, this treatment either cures symptomatically or 
ameliorates considerably. 

(4) The effect of this treatment is rapid, and it requires no 
adjuvant. 

These remarks of Gautier were followed by a statement from 
Apostoli, published in the official bulletin of the French 
Electro-Therapeutic Society : 

The galvanic treatment of vomiting has just received a new 
baptism before the medical society of the Parisian hospitals 
. . . . of which I could not but approve, were it not my 
duty to show, incidentally, the lapse of memory of one of the 
physicians, who seems to forget that in 1882-3 and 4 he has 
seen applied daily at each of my clinics the same procedure 
which he extols thirteen years later. 

True, he has changed a single unimportant detail in the 
technique, but the rest is a perfect reproduction. 

Vomiting occupies as a symptom a large place in pathology. 
Hysteria and pregnancy offer us typical examples which we 
can readily observe and study the respective value of the 
various medicaments used to control it. 

In all works upon electro-therapeusis will be found more or 
less precise indications for the application of electricity in 
stomachic affections. Tripier formulated the galvanic thera- 



TREATMENT OF VOMITING OF PREGNANCY. 49! 

peutics of vomiting, which I shall now discuss and call your 
attention to my modification of the operative technique. 

On the nth of August, 1882, I read before the Medical 
Society of the Parisian hospitals a note (based on twenty-eight 
favorable observations) on the electric treatment of hysterical 
gastric derangements (emesis, gastralgia), in which I extolled 
the descending galvanization -f- pole, of the right pneumogas- 
tric with a continuous current, of small quantity and of long 
duration. 

Many previous experiments made at my clinic had demon- 
.strated that the position of the other electrode was absolutely 
indifferent; therefore, simply on account of its ease of a.pplica- 
tion, I have used the hand of the opposite side to close the 
circuit. 

Shortly after, I applied the same therapeusis, with equal 
success, first in the vomiting of pregnancy, and then in a large 
number of gastric troubles, caused by various pathological 
stomachic lesions. 

Moreover, I have, after a large number of comparative ex- 
periments, modified and improved my first operative technique, 
increasing its remedial action by galvanizing simultaneously 
the two pneumogastrics — but always with a small dose of long 
duration. 

In August, 1884, I read a second paper, before the Inter- 
national Medical College, at Copenhagen, on the application of 
electricity to gastric derangements, and there treated at length 
the vomiting of pregnancy. 

Since then, a practice of ten years has demonstrated the 
value of this technique, which I recommended in 1882 and 
perfected in 1884. Allow me to explain it to-day, by noting 
its important points and by substantiating it with my very 
complete experience. 

Whatever the nature of the vomiting, whether it be hysteri- 
cal or is connected with some gastric derangement, as that of 
pregnancy, for example, the operative technique is the same 
and consists of a number of minute details which must be 
carefully observed, for my practice has shown that, especially 
in grave and intractable cases, all the success of this method 
depends on their scrupulous observance. 

- In my first paper on this subject I have studied successively 
the nature, place and time of the applications, their dose, 
duration, and the number. I wish to explain again the chief 
points of formulating the rules which are attached to them. 

I. Nature and Place of the Application. — In 1882, I 
repeat, I adopted exclusively the + galvanization of one of 
the pneumogastrics, and applied, always successfully, to the 



492 TREATMENT OF VOMITING OF PREGNANCY. 

right side. Later, some failures and parallel comparative ex- 
periments made me modify my first method, and I suggested 
the simultaneous galvanization of both vagi. It is this latter 
method, confirmed and strengthened by long experience, 
which I now recommend as being the most rapid, the most 
active and the easiest to apply. 

It consists of placing two small equally-sized electrodes at 
the inner angle of the clavicles, at a point as near as possible 
to the trunk of the vagus. 

As a matter of fact, it is the galvanization of this nerve at 
its most accessible place, and one which is easily found by the 
patient. Each electrode is placed about a centimeter from 
the end of the clavicles, grazing the upper surface of the bone, 
at the level of the depression which is left between the two 
heads of the sternocleidomastoid. Each electrode, usually 
held by the patient, should be small, about the size of a franc, 
in order to increase the density of the current at this level and 
to concentrate it in situ, that is to say, on the subjacent parts, 
including the vagus. 

The electrode consists of a carbon button covered with 
gauze, conical or flat, according as a greater or less penetration 
is desired. 

The current of the battery should be constant and all inter- 
ruptions should be avoided. It is preferable to use a rheostat 
in order to avoid a shock, either at the beginning or end of 
the treatment. 

II. The Dose. — The quantity of the current depends on 
the tolerance of the patient and the resistance to be overcome. 
There are two guiding rules : cure the patient ; do not need- 
lessly cauterize the skin. 

The average dose varies from 5 ma. to 10 ma., but it is nec- 
essary occasionally to raise it — usually for an instant — to 15 
ma. This is also done gradually and following the indications 
given by the patient. 

The patient should be instructed to watch his sensations 
and tell the operator — particularly of nausea — that the quan- 
tity of current may be properly regulated. 

Then by watching the meter and adjusting the current, all 
the fluctuations may be observed. 

If, from the beginning, the current rises steadily to 5 ma. 
and the patient feels a considerable amelioration, all nausea 
disappearing, the limit is reached, for it is useless to increase 
the dose. 

If, on the contrary, vomiting is immanent during the treat- 
ment itself, it is necessary to increase the quantity, immediately 
and rapidly, until one of two things occurs ; either the patient 



TREATMENT OF VOMITING OF PREGNANCY. 493 

feels better, or complains of the burning. Then diminish the 
current, and run it up rapidly to about 5 ma. Then stop and 
increase it again at each sign of a return of the nausea pro- 
dromal of the next vomiting. 

I believe that much of the success of galvanism in vomiting 
is due to the adaptation of the dose to the gravity of the evil, 
and certainly the variety is infinite, from simple, unimportant 
reflex vomiting to the intractable emesis which threatens the 
life of certain pregnant women. 

It is to be remembered that women present a great differ- 
ence of cutaneous sensibility, especially about the neck, and 
it is not wise to shock by an overdose which caa provoke 
severe pain. 

It is preferable, in the beginning, to keep to a medium dose, 
to acclimate them in a way, and to allow the moistening of 
the skin by the electrodes, with its consequent diminution of 
resistance. 

III. The Duration. — The duration should be, as the 
quantity, proportioned to the gravity of the trouble, and, as a 
general rule, I say that no sitting should be ended until it 
produces an effect. It should then be continued until the 
patient says she is better, and not stopped until all nausea has 
gone and a normal condition been re-established. 

It is therefore impossible to determine, as some of my pre- 
decessors have done, the duration of the treatment with mathe- 
matical exactness. 

It is necessary to continue the application until the patient 
admittedly feels well, and has no desire to vomit. Further, it 
is jiecessary to be prepared to recommence at the first sign of 
a return for some time after the first treatment. 

So from five minutes to an hour, with the time for resting, 
may be said to be the proper duration of the first treat- 
ment. 

There is no necessity in the beginning of being discouraged. 
Only wait. The stomach, accustomed to vomiting, frequently 
commences by emptying itself. Often it has the characteris- 
tics of another attack. It is, therefore, necessary to wait until 
the patient says spontaneously : " I feel better, I do not think 
I shall vomit any more." 

The average duration varies from ten minutes to twenty, 
and more, but it must be known that it can and ought to be 
continued much longer in some rare cases, and in these care 
must be taken not to scar the skin. 

IV. The Time.— ^Galvanism having rather a curative than 
prophylactic action, it is better to treat during digestion to 
combat the dyspepsia, or the vomiting. 



494 TREATMENT OF VOMITING OF PREGNANCY. 

So the patient is made to eat, and the current, if applied 
then, will insure digestion and prevent emesis. 

This indication is important, the vomiting should be imma- 
nent, and the spasm arrested ; that is, the patient being put in 
a condition favorable for vomiting and the crisis averted, the 
pathological habitude of the stomach is broken as the pneumo- 
gastric irritation is calmed. 

This is how I proceed : 

First Time. — I make a preparatory treatment with a small 
current, for two or three minutes, the stomach being empty. 

Second 7"mf.^ Without interrupting the stance, I make the 
patient eat, little by little, or drink that which is said to be the 
most apt to cause vomiting. I thus precede the difficulty by 
overcoming it step by step from the beginning. 

Third Time. — I continue the current for a variable length 
of time after the ingestion of food or drink. 

V. Number of Treatments. — The treatments should be 
frequent at first, and in the beginning all digestion should be 
helped by the galvanism. Later, as amelioration is observed, 
the intervals are lengthened. Here, again, the variable per- 
sonal element enters, and the method depends on the condi- 
tion of the patient. 

A single application may cure a case of intractable vomiting, 
though more frequently a second and a third will be found 
necessary. 

The convalescent stomach often has a relapse, and it is wise 
to help it fulfil its function by several treatments, in order to 
prevent this. 

Usually two treatments are given each day — one in the 
morning and one at night — particularly if the first was not a 
complete success, and a relapse should not be allowed. 

In 1882, from eight cases, four of them intractable, T told 
how none had vomited during the first treatment, how some 
again in the evening and the next day, and that from one 
to eight treatments sufficed to effect a cure. 

Later experience confirms this, and, especially in pregnancy, 
a relapse is equally well treated in the same way. To recapit- 
ulate, this is a uniform treatment which I systematized in 
1882, and which I have used exclusively, and always success- 
fully, hundreds of times for vomiting. 

It consists of descending galvanism, or -|- pole, applied to 
the right, or, better, to both pneumogastrics, with variable 
dose and duration, and stops almost at once the derangement, 
be it epigastralgia, gastralgia or vomiting, in such a way as to 
leave beyond question the action on the vagus and its patho- 
genetic importance. 



TREATMENT OF VOMITING OF PREGNANCY. 49S 

I would add that this proceeding has no effect on sub- 
mammary, umbilical or ovarian neuralgias, and that its action 
seems limited to the gastric region. 

Have I, then, caused some sort of a diathesis ? No. The 
galvanism, given as above, stops a symptom ; that is all. If a 
relapse occurs, it will stop it again. 

Thus, by preventing the manifestation of a symptom — pain 
or spasm — a normal process is substituted for a morbid habit. 

Finally, the continuous galvanic current, properly given, is 
the treatment for the symptom, whether it be dyspepsia, gas- 
tralgia or vomiting. If the symptom is purely reflex, as, for 
example, the vomiting of pregnancy, the action is immediate 
and supreme. In other non-carcinomatous cases it is extremely 
valuable as an active adjuvant to the classical therapeusis. 

Graily Hewitt urges that a proper distinction be made be- 
tween the vomiting of pregnancy which is produced by and 
directly dependent upon the condition itself, and vomiting 
occurring during pregnancy yet due to diseases or causes -not 
connected with the pregnant state. In twenty-four cases out 
of one hundred recorded, the severe vomiting was found to 
have for its origin one of the following abnormities : chronic 
gastritis, gastro-enteritis, cancer of the pylorus, carcinoma of 
the liver, biliary calculi, fatty degeneration of the liver, pul- 
monary and cerebral tuberculosis, polypoid disease of the 
intestines, etc. These cases of severe vomiting all resulted in 
death, and the post-mortem examinations revealed the fact 
that definite lesions existed causing the distressing condition, 
that was not directly due to the physiological process that was 
going on. 

In the majority of cases in which severe vomiting marks a 
process that should be purely physiological and without disas- 
ter, there are usually present abnormal conditions in or about 
the uterus. There may be displacements, or induration, 
thickening, contraction of the cervix, or inflammatory effusions 
in the vicinity of the uterus. Relief of these abnormities 
usually stops the vomiting. In other instances induced abor- 
tion is the only cure. Even this is at times inefficacious, so 
profound is the exhaustion induced by the previous chronic 
starvation. Innumerable drugs have been recommended, most 
of them quite useless in severe cases. Those likely to be of 
service are sedatives — cocaine, opium and the bromides. 
Local medication is of benefit in some instances. Vaginal 
tampons saturated in poppy decoction are of great use ; also 
cocaine applied to the os or to the interior of the cervical 
canal, and caustic applications, Hot douches not too frequent. 



496 TREATMENT OF VOMITING OF PREGNANCY. 

and rectal suppositories containing opium, morphine, bella- 
donna or hyoscyamus, suggest themselves as valuable aids. 
The administration of food is of great importance. Sometimes 
the stomach will retain nourishment given in minute quanti- 
ties and at frequent intervals. In certain cases starvation can 
be prevented for a time by the systematic use of suppositories 
containing nutrient substances. Each case must be dealt with 
on its merits. Good food, nerve tonics, fresh air and general 
hygienic measures may give relief when the trouble is not 
severe. Rest in fair amount Hewitt insists upon, and the 
horizontal position, maintained in varying degree of strictness, 
is essential in all cases. — Medical Record. 

A study of the subject from the above standpoint discloses 
the fact that none of the ordinary remedies equal the varied 
resources of electro-therapeutics, in the presence of difficult 
complications, especially when these are in or about the 
uterus. 



CHAPTER XXIX. 
UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

Medical methods. Clinical varieties of fibroid tumours. Surgical methods and 
indications for each. Indications for galvanic electricity and other currents. 
Relative place of electrical methods as adjunct to medicine and surgery. The 
tediousness of any form of treatment. Clinical results in different varieties 
of cases. 

Uterine Fibroids and the Treatment of Patients. — The 

practical treatment of patients possessed of benign tumors of 
the uterus depends upon three things : (i) The physician, and 
his. armamentarium ; (2) the patient, and her circumstances ; 
(3) the tumor, and its comphcations. 

For complete treatment we now possess the fully ascertained 
resources of drugs, electric currents and surgical skill. Two 
or more methods must usually be combined to secure the best 
results in any case. In no case is a single method complete in 
itself, and medical, electrical and operative methods have all 
been brought to a high state of perfection and are ready to be 
selected from according to the given case. 

Each patient is practically a law unto herself, and theoretical 
indications for operative interference offer the least help to in- 
fluence the physician's advice. Barriers of a practical nature — 
the circumstances of the patient, domestic necessities, family 
affairs and mental convictions — sometimes interpose to pre- 
vent either radical or conservative measures for the removal of 
the tumor. The patient, however, must be given the best treat- 
ment that circumstances make available, and to this end let us 
see what can be done. 

The first thing to consider, even before any accurate diag- 
nosis of the exact nature of the tumor need be attempted, is 
the general health of the patient, for constitutional good health 
32 497 ■ 



498 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

and a fibroid tumor either do not exist together at the first 
examination or will soon drift apart, for the tumor flourishes 
at the expense of nutrition. 

Treatment of the nutrition of the average patient is there- 
fore the first step, and to medical remedies to improve nutria 
tion can be added others for special effects. These include a 
great variety of drugs yvhich may be divided into general 
tonics, sedatives, anodynes, alteratives, uterine tonics, hemo- 
statics and ergot. When hysterectomy had a dread mortality 
rate and electrical methods were in an experimental stage of 
development, almost the whole treatment of fibroids was drug 
treatment and the useful remedies have been determined by 
experience. 

If the patient can by some means be kept at the point of 
greatest natural tonicity the tumor will not increase rapidly in 
size. Prescribe abundant nourishing food, gentle cholagogue 
laxatives and the bitter tonics, especially cinchona. In all cases 
of anaemia prescribe iron and the hypophosphites. 

Dr. Bedford Brown a few years ago reported 27 cases treated 
mainly by the free use of the hypophosphites, strychnia and 
ergot. The cases included all classes from those without 
marked symptoms to others exceedingly grave, accompanied 
by alarming hemorrhagic tendencies, peritonitis, septicsemia 
and general prostration. Most of the cases had remained under 
observation from five to fifteen years. In all there had been 
improvement and in one-third positive recovery. 

In grave and serious cases he administered as much as a 
dram of the syrup of hypophosphites of lime and soda every 
two or three hours, and two drams of the lactophosphates three 
times daily, until the saturation of the circulation restored the 
lost equilibrium of nutrition, arrested cell profileration- and 
exudation and promoted absorption. 

Along this line of tonic treatment we find extensive direc- 
tions in text books, including salt baths, changes of climate 
and sea voyages ; but practically all needed supplementary 
action to the foundation measures stated above may be best 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 499 

ibtained by the use of electricity in some form. Electrical cur- 
•ents are the sheet anchor of conservative measures. 

I will speak of local measures later, but for the general treat- 
ment of nutrition and the relief of reflex and nervous symp- 
:oms we have in the static apparatus the simplest, most 
Dractical and most satisfactory means of doing these patients 
jood by electricity. 

Static methods of general treatment. — Seat the patient in 
in easy high-backed chair upon the static platform in the 
Host comfortable position possible. Fibroid patients are 
learly always anaemic, nervous or neurasthenic, or subject 
:o aches, pains and reflex disturbances. The expert will at 
jnce know how to conform the method to the indications of 
;ach case, but the physician who is not practised in the man- 
igement of the static machine may be guided by the following 
iirections. 

At the first sitting connect the platform to the negative pole 
jf the static machine, ground the positive pole and start the 
nachine into moderate action. If two or three moments dem- 
onstrates that the patient is not timid and that no alarm is 
:aused by the .simple negative electrification stop the machine 
md change the platform connection to the positive pole, 
jround the negative pole and again start the machine into 
noderate action. 

At the first sitting simple electrification should be maintained 
or fifteen or twenty minutes and the patient allowed to be- 
:ome acquainted with the machine and its action so that at 
;he next visit she will feel no nervousness. 

The subsequent conduct of each case must depend upon the 
najor symptoms. If the patient is neurasthenic, or hysterical, 
)r rheumatic, or subject to headaches, insomnia, or any of the 
unctional neuroses, we may derive benefits from static elec- 
ricity which cannot be equalled in any other way, and the 
nethods to employ may be selected by referring to the chap- 
ers upon these diseases. 

One of the practical points of superiority over administra- 



500 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

tions with currents which require disrobing and the use of 
moist electrodes is the facility with which static currents pro- 
duce their general as well as local effects without any disrob- 
ing whatever. The physician who treats pelvic diseases 
should especially study the electrical treatment of neurasthenia, 
insomnia, pain and functional derangements, for in these 
conditions the different electrical currents are indispens- 
able. 

The sedative drug remedies usually employed are those which 
relieve severe menstrual pains, allay nervous irritability and 
promote sleep. They include opium, all the coal tar anodyne 
preparations, chloral, hyoscyamus, cannabis indica, the bro- 
mides, sulphonal, belladonna, gelsemium, valerian, asafetida, 
zinc, and a number of others ; but, except as temporary ex- 
pedients, these are quite . successfully displaced by static 
electricity, bipolar faradization and the galvanic current. 

For the relief of symptoms the majority of the above drugs 
have no curative action and are dangerous or injurious when 
long continued. The resources of medical electricity save the 
patient from the risk and ill-effects attending the continuous 
use of drug palliatives. 

The employment of so-called alteratives includes two 
remedies of great importance, no matter what other plan of 
treatment is adopted. These are arsenic and mercury. Five- 
drop doses of Fowler's solution may be added to the dose of 
hypophosphites which is taken after each meal. 

As a gentle laxative the cholagogue and tonic action of 
calomel (tablet triturates, 1-20 or i-io grain doses — every two, 
three or four hours daily according to the needs of the patient) is 
invaluable. Follow the laxative action with a mild saline before 
breakfast and use the calomel a few days at a time and return 
to it whenever it is needed. The tongue furnishes a very sure 
indication for its use. Electricity does not supply the action 
of this remedy without more troublesome applications than 
are ordinarily acceptable. 

Of the other special remedies the chief are local astringents 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 501 

applied to the mucous membrane of the uterus and the internal 
haemostatics, ergot and hydrastis. 

Practically all local astringents and local applications of a 
medical nature are made obsolete by the immensely superior 
action of electric currents. 

Ergot and hydrastis are the best internal remedies to con- 
tract the blood-vessels and modify the hemorrhage. They 
are given three or four times a day. One grain each of the 
solid extract in pill form or capsules obviates the disagreeable 
taste of the fluid extracts. To modify flowing during profuse 
menstruation the patient should take at least a half dram of 
each three times a day while the flow is excessive. 

The employment of electricity not only supplies the action 
of these two drugs but goes far beyond them in its effects. 
At an advanced stage when the growth of a fibroid has prac- 
tically abrogated the contractility of muscular fibres, ergot 
ceases to play its great r61e as a haemostatic. 

Ergot and hydrastis may be considered indispensable to 
the medical treatment of fibroids, but when skilled electrical 
methods are employed they lose their importance. Electrical 
currents will not interfere with the physician who deems it 
wise to prescribe them, but as a rule very few drugs are 
required to supplement resources of electricity when these 
are all utilized. 

Ergot, however, is most useful in the treatment of sub- 
mucous fibroids and those which tend to become peduncu- 
lated, while electricity hands over to the surgeon most cases of 
this variety. 

The surgical treatment of uterine fibroids involves two 
classes of operation, one directed to about the same end a's 
electric methods, leaving the fibroid in situ and cutting off its 
nutrition. The other eradicates the tumor, and, if necessary, 
everything else. As operative methods have been brought 
within recent times to a remarkable stage of perfection almost 
all that the physician reads in standard text books published 
more than a couple of years ago is out of date, and some of 



502 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

the wholesome dread of patients to consider operations for 
benign tumors is now uncalled for. Surgery, however, still 
has a mortality rate, while electricity has none, and mor^e- 
over surgery must always be regarded from four separate 
standpoints which are quite apart from theoretical indications. 

In the hands of the very few masters of skill and judgment 
any patient upon whom they would consent to operate is prac- 
tically safe so far as danger to life is concerned, but in quite a 
number of cases the patient fails to secure all the curative 
benefits desired. 

In the hands of less experienced operators whose facilities, 
judgment and skill are not matured, the percentage of disaster 
will be much greater, and they should properly consider only 
the simpler forms of operations. 

The third standpoint is that of the general practitioner who 
does not operate himself but seeks to advise his patient. 
This chapter is intended to assist him in forming his own 
judgment. 

The fourth .standpoint is that of the patient herself, and 
more often controls the decision than does the skill of the 
most brilliant operator. 

Contrary to the popular belief, however, it is not always in 
simple cases that any grave question of choice arises between 
surgery and electricity, but it is quite often in complicated 
cases, with septic absorption, and when an operation would 
be suicidal and injure the surgeon's carefully cherished statistics 
of recoveries, that he voluntarily shifts the responsibility from 
the knife to another agent. In these desperate cases as well 
as in hundreds of others electricity has a record of success. 

The clinical varieties of fibroid tumors of the uterus are 
usually separated into three groups, but are divided mio four 
groups by Dr. Franklin H. Martin, of Chicago, to whose recent 
lectures I am indebted in preparing this chapter. The terms 
employed are : 

Interstitial. — A tumor uniformly distributed throughout the 
body of the uterus. 55 per cent, of all cases. 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 503 

Intramural. — Fibroid growth from one or more distinct 
centres of development confined to the wall proper of the 
uterus. 15 per cent, of all cases. 

Subperitoneal. — A fibroid projecting from the walls of the 
uterus into the peritoneal cavity and tending to become 
pedunculated. 20 per cent, of all cases. 

Suhnucous. — The same kind of a fibroid projecting from the 
walls of the uterus into the uterine cavity. It may become 
pedunculated. 10 per cent, of all cases. 

It is in the interstitial and intramural varieties, which make 
up an estimated 70 per cent, of total cases, that we have 
chiefly to consider a choice of treatment, for it was in these 
cases that surgery was most fatal even ten years ago, while 
electricity was benefiting 95 per cent, of all patients properly 
treated and destroying none. 

The following indications for different methods of treatment 
are cited from Martin. 

Abdominal Hysterectomy.— Successful abdominal hyster- 
ectomy is the only absolutely sure cure for large fibroids of the 
uterus. Ergot, electricity, ligation of the blood supply, will 
cure a certain percentage, but hysterectomy removes at once 
every vestige of the tumor and with it the uterus on which it 
propagates. 

The operation of abdominal hysterectomy in its present 
condition of perfection, in the hands of experienced operators, 
should be the operation of selection for all fibroids which can- 
not be removed by vaginal hysterectomy when the patient is 
in a physical condition which will not jeopardize her imme- 
diate recovery from the operation. 

Multiple intramural fibroids of every kind which are pro- 
ducing distressing symptoms should be submitted to hyster- 
ectomy because there is no absolute cure for them by any 
other means. 

Subperitoneal fibroids, when multiple, can only be removed 
by abdominal hysterectomy, and no other treatment will reach 
them. 



504 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

Interstitial fibroids of large size, of hemorrhagic nature, 
should always be treated by abdominal hysterectomy if the 
patient is in a fair physical condition. 

Cystic fibroids can only be cured by hysterectomy. Any 
form of treatment less radical only aggravates these cases.' 

Suppurating fibroids imperatively demand hysterectomy. 

Fibroids complicated with pelvic suppurations, pyosaJpinx, 
suppurating ovaries or appendicitis, should be removed at the 
same time that the pelvis is cleaned out. 

Large fibroids complicated with pregnancy where there is 
the slightest doubt of a successful normal ending of the con- 
dition of pregnancy demand abdominal hysterectomy. 

In all the above cases only the latest and mo.st improved 
technique is understood. 

Vaginal Hysterectomy. — Vaginal hysterectomy has two 
divisions, one removing the uterus and its tumor en masse, 
and the other removing them piecemeal — inorcellement. 

The first operation is often the ideal method of treating 
small multiple fibroids which are so frequently the site of 
severe uterine pain and excessive hemorrhage. Fibroids of 
considerable size may be treated by vaginal hysterectomy 
when the uterus is low in the pelvis and the vagina is large 
and the tissues loose. The skill of the individual operator 
controls the scope of this method. 

Vaginal hysterectomy by rnorcellement may be done for 
fibroids of considerable size, but some operators prefer the 
abdominal method when the uterus is too large to deliver 
easily after bisecting. The method may be employed : 
I. Whenever the mass is largely within the pelvis, especially 
if it is fixed therein by adhesions. 2. Whenever the mass is 
soft and therefore compressible. 3. In all other cases where 
we have a patient in good condition, whose pelvis is shallow, 
where the vaginal canal is roomy. 

Whether suppurating appendages prevent this method of 
operating depends on the skill of the individual surgeon. 

Removal of Uterine Appendages.— But a few years ago this 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 505 

was the operation of selection for the relief of uterine fibroids, 
but is now limited to a much smaller number of cases than 
formerly. It is employed : i. When for some reason there 
exists a prejudice against sacrificing the uterus. 2. In cases 
when for some good reason brevity of time in operating is 
desirable. 3. In cases where unusual complications, revealed 
after the abdomen is opened, make hysterectomy impracticable. 
4. In cases of small bleeding tumors in weak women who are 
near the menopause. 5. In cases of small hemorrhagic fibroids 
in weak women which are complicated with diseases of the 
appendages but for which laparotomy would not otherwise be 
ordinarily indicated. 

Vaginal Ligation of the Broad Ligament (Martin's Opera- 
tion). — This operation aims to occlude not only the main 
channel of the uterine artery but all collateral branches in 
order to destroy the function of the nerves as well as the 
arteries of nutrition. 

Interstitial fibroids of moderate size are the cases in which 
the best results will be obtained by this operation. The cases 
in which the most satisfactory results must be expected are 
incipient or small fibroids of the interstitial variety which show 
themselves late in life. 

In true interstitial growth depending upon the whole uterus 
for their nourishment, where in fact the tumor is the uterus, 
and these represent 75 per cent, of all fibroids, this operation 
may be expected to accomplish prompt and decided relief of 
symptoms and a rapid reduction of the tumor when it is 
possible to tie the base of the broad ligament from the vagina. 

When we have a uterus which is so small that it has not 
risen above the brim of the pelvis so that its broad ligaments 
are accessible from below, the major operation is particularly 
undesirable, because from the age of the patient the fibroid 
will soon reach a state of quiescence through the menopause. 
The ideal cases for the Martin operation are cases of the above 
character with severe hemorrhage as a principal symptom de- 
manding immediate relief. It may also be employed with 



5o6 UTERIKE FIBROIDS JiND TREATMENT OF PATIENTS. 

• success in cases of continuous and pro/use hemorrhage which is 
depleting the patient so seriously that no radical procedure can 
be thought of until a minor operation has checked the waste 
of blood and made recuperation possible. 

While this operation has only a limited application in fibroid 
conditions of the uterus, it possesses some advantages which 
commend it, viz. : 

1. It involves little or no risk when carefully executed. 

2. It does not involve a tedious convalescence. 

3. It is quickly and easily performed. 

4. Its immediate result is to afford prompt relief of the 
symptoms. 

5. Its ultimate result, which is manifest within six months, 
is complete or almost complete atrophy of the tumor. 

6. It does not unsex, mutilate, or disable the patient. 
(Goelet) 

Indications for Electricity. — Galvanic— V^MCaowt regard to 
theoretical prognosis or the restrictions of circumstances it 
may be considered that the galvanic current is practically 
indicated : 

In bleeding fibroids in women approaching the menopause. 

In all bleeding fibroids of the smooth interstitial variety 
which have no symptoms but hemorrhage. 

In all inoperable cases. 

In incipient fibroids in women of any age and especially 
when near the menopause. 

In all cases of the interstitial variety not accompanied with 
pelvic pus accumulation and cystic ovaries. 

In all cases which refuse an operation. 

Subperitoneal and submucous fibroids, constitutfng an esti- 
mated 30 per cent, of all cases, are practically outside of direct 
local curative treatment by galvanic currents. In practice 
some other cases in which the galvanic current is apparently 
indicated will fail to derive entirely satisfactory results. 

Indications stated in this general way give an imperfect idea 
of the wide range of practical usefulness contained in the 
different electrical currents. They will appear more in detail 
when we consider individual cases. 



UTERIXE FIBROIDS AND TREATMENT OF PATIENTS. JO/ 

Induction Coil Currents.— hs, an adjunct to the electrolytic 
properties of galvanic currents we hdM&m vaginal bipolar fara- 
dization a method of great utility for the relief of symptoms 
and the improvement of nutrition. Reference to the chapter 
upon the physiological action of rapidly interrupted high- 
tension currents will point out the uses of this superb aid to 
the treatment of some patients with uterine fibroid. 

Static Electricity. — Next to the direct attack upon the ab- 
normal growth by galvanic and induction coil currents the 
most important service in the treatment of the patient and her 
nutrition is rendered by static electricity. It combats the 
symptoms of general debility, backaches, neurasthenia, in- 
somnia and nervous disturbances, without waiting for the 
slower action of electrolysis. Its value cannot be appreciated 
until its effects are witnessed. It is a tower of strength to 
rely upon in the office and in the hospital where pelvic diseases 
are treated, and in imparting strength to weakened muscles, in 
improving digestion, promoting sleep and releasing the patient 
from the bondage of sedatives and hypnotics it acts as a res- 
torative agent of very great practical value. 

Comparative Arguments about Operative Methods. — 
It is argued that " hysterectomy removes at once every 
vestige of the tumor and is the only absolutely sure (?) cure." , 

" It is argued that a patient suffers less real shock ordinarily 
when subjected to a vaginal hysterectomy than when operated 
upon through the abdomen. A vaginal hysterectomy avoids 
the abdominal scar which so many patients dread as a brand 
of mutilation which must be carried through life after all 
abdominal operations. 

" Many patients have this wholesome dread to such a degree 
that there seems to be no comparison in their minds between 
the two operations. An abdominal operation contains all the 
horrors of most dreaded surgery, while a vaginal operation with 
no sign of mutilation left is contemplated like a normal labor 
with dread but with resignation. 

"An abdominal scar it is true will frequently become the 
site of considerable irritation and in rare cases the site of 
severely neuralgic pains. There is always, too, the remote 



5o8 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

possibility of ventral hernias developing in an abdominal 
scar. 

" However, as soon as we undertake to do a vaginal hysterec- 
tomy on anything but the smallest kind of a fibroid we are 
hampered by the narrow limits in which we have to do our 
work, and therefore if the tumor is of considerable size it re- 
quires an extra time for its proper removal through the vagina, 
which offsets the advantage gained by non-exposure of the ab- 
dominal viscera. 

" The rational surgeon must discriminate here as everywhere 
else in surgery and select the operation which best suits the 
individual case. If he has a small fibroid, or a large fibroid 
with relaxed ligaments and a large, roomy vagina, he should 
select the lower route ; whereas, if he has a large fi.broid high 
in the pelvis, or a small one with a narrow contracted vagina 
and rigid tissues, he should do a laparotomy and remove the 
tumor from above. 

" The operation of removal of the appendages fails about 
three times in thirteen recoveries to materially reduce the size 
of the tumor, and fails in one case in thirteen recoveries to 
produce an artificial menopause, while hysterectomy is abso- 
lutely sure of eradicating both the tumor and the hemorrhage 
in every case that recovers from the operation. Removal of the 
appendages is seldom performed at present except as a last 
resort when laparotomy for the purpose of hysterectomy has 
been instituted, but because of contra-indications the major 
operation is found' inadvisable." (Martin^ 

The present status of the treatment of benign tumors of the 
uterus by electricity is also well summed up by Martin in the 
following language : 

" As an abdominal surgeon with at least average success, and 
at the same time as one who interested himself early and en- 
thusiastically in the Apostoli treatment when it made its ddbut 
in this country, I am constrained by a sense of justice, know- 
ing well both sides, to say in the interest of those who have 
fibroids of the uterus that the knife, even in these times of 
brilliant successes in surgery, is used too often and electricity 
too little. 

" If a brilliant hysterectomy withits average mortality of five 
per cent, ended the matter and the 95 per cent, surviving gained 
health immediately we could have but little to say. When, 
however, we must reckon on the months of nervous suffering 
with which the majority of these patients who have their 'tumors 
removed have to contend after this operation before they receive 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 509 

the well-earned cure, and when tve take into consideration the 
not large but certain percentage of fistulas, hernias and other 
well-known distressing segue Ice follotmng operations, and last, 
but not least, when we remember the grim spectre of that five or 
ten per cent, who did not recover, are we not justified, if we 
have a conscience (especially when we realize that a fibroid of 
the uterus when left alone seldom proves fatal), in giving our 
patients the benefit of a treatment which seldom fails to relieve 
these cases, and which, if it frequently fails to cure, never kills, 
never does harm, and never interferes with the success of an opera- 
tion if it in the end fails to cure. 

" Experience in the treatment of fibroids of the uterus by 
electricity has taught me how to select my cases, when to en- 
courage a patient to receive electricity and when to encourage 
her to select an operation. In some desperate cases in which 
submitting to an operation would be clearly suicidal I believe 
that electricity not only offers a straw of hope to these patients, 
but a veritable life-boat to their despairing bodies." 

The principle of all forms of treatment which do not cut the 
fibroid out aims to starve it out. This denutritive principle 
applies alike to drug treatment, electrical treatment and all 
the operations upon the blood supply and the appendages. 

In discussing electricity or surgery versus each other (with 
the patient's view left out) writers may speak from the narrow 
standpoint of partisanship for the method they prefer, and 
whether they advocate electricity or give it but faint praise 
they most often speak of the action of the galvanic current 
alone. This does far less than full justice to the practical 
resources of electric currents, and underestimates by a large 
percentage the benefits they can confer to both physician and 
patient in the treatment of fibroid tumors in one of four dif- 
ferent ways : 

1. To constitute the main treatment in the large number of 
interstitial fibroids to which electrical methods are adapted and 
thus accomplish the satisfactory results of at least a sympto- 
matic cure without a surgical operation. 

2. To aid the action of other remedies to put the patient in 
the best possible condition, both mentally and physically, for 
the ordeal of any necessary operation. 

3. To combat the sequelae of a major operation, relieve the 
syrnptoms left over, repair the damages of shock, restore the 



510 UTERINE FIBROIDS AXD TREATMENT OF PATIENTS. 

nerve forces and put the patient most quickly on her feet. 
For these purposes electricity is as valuable after surgery eradi 
cates a tumor and until recovery is complete as it is at any time 
in the treatment of any other patient. 

4. To come to the rescue in desperate and hopeless cases 
when as a last resort it can be employed safely when an opera- 
tion would be fatal. In cases of this character its achievements 
take rank with the most brilliant accojnplishments in the domain 
of medicine. 

Other things being equal, the "symptomatic cure" obtained 
by the aid of electricity without surgery is often better for the 
patient, and more thoroughly satisfactory than results called 
by the same name, achieved by operative methods minus 
electricity. 

Those who judge of electricity only by the action of the 
galvanic current upon the size of the tumor, and do not take 
into account its nutritional, sedative-tonic, nerve composing, 
and muscle strengthening properties fall far short of measuring 
its true value in the treatment of patients. 

Before referring to the specific details of treatment there is 
one point not sufficiently recognized by the profession. It is 
customary to say that hysterectomy (for instance) removes the 
tumor " at once " while the " slower method of electrolysis is 
tedious, exacting and takes a long time." 

It is true that the surgeon performs the operation in an hour 
or less, but let us see about the patient. 

For either a vaginal or abdominal hysterectomy she gives 
up her whole time for hospital preparation for a period which 
varies with her general health, but let us call it ten days before 
the operation. 

After the operation she is a prisoner in bed on a fluid diet 
for the first week and by no means to be envied so far as com- 
fort is concerned. For the second week after the operation 
she is kept on semi-solids ; and it requires nearly four weeks 
to fit her system to resume a mixed diet of substantial food. 
If she sits up at the end of three weeks she is doing well, and 
if she is able to leave the hospital within thirty or forty days 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 511 

after the operation she has made a good recovery. This has 
required, let us say, about fifty days during which the patient 
has given up every moment of her time to preparing for and 
recovering from an " instantaneous " cure. 

How much of her time will be sacrificed during the succeed- 
ing months of nervous suffering which the majority of these 
patients undergo after an operation need not be estimated 
exactly, but let us say that a woman with an interstitial fibroid 
of medium size escapes all the fistulas, hernias, neuralgias and 
neurotic sufferings which sometimes keep her an invalid for 
years and scores the brilliant and rare result of a complete 
recovery from both the fibroid and all its symptoms in two 
months. 

She has in this case spent 1,440 consecutive hours in passing 
through an ordeal not wholly unattended with danger to life 
and which has taken from her during that time all power to 
attend to her social, domestic, family or business occupations. 
Let us compare the time thus consumed with the time de- 
manded from her by the " slower method " of electrolysis. 

The ordinary application of the maximum galvanic current is 
from three to five minutes, but the application of the electrodes 
and the increase and reduction of the dose will consume about 
fifteen minutes. 

With the facilities which every operator possesses who 
treats these cases, the irrigation of the parts and the entire 
treatment will not average over twenty minutes. Let us add 
fifty per cent, to this to be devoted to a static or coil adminis- 
tration and call each stance half an hour. 

After the seance the patient who is not sick enough to be 
confined to her bed by the disease is not confined to her bed 
by the treatment, and she is free to go home and rest, visit, or 
pursue the ordinary vocations of her life, with strength which 
increases steadily. 

To equal the demand upon her time required by the surgical 
operation, which kept her either in bed or a house prisoner for 
sixty days, she must receive 2,880 electrical treatments aver- 



512 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

aging one half-hour each. As a matter of fact some cases re- 
ceive only twenty treatments, some forty, some sixty or 
more, and while symptomatic relief may possibly begin 
almost at the first treatment and usually runs far in advance 
of anatomical reduction in the size of the tumor it is probable 
that the majority of patients who have been treated by this 
method by competent operators throughout the world have 
received not more than an average of fifty galvanic treat- 
ments. 

The direct tax, therefore, of fifty treatments would equal 
twenty-five hours as against 1,440 hours of absolute sacrifiGe 
to the surgical operation. 

Eliminating from both methods all complications and con- 
sidering that the best possible results of an electrical cure are 
equal to the best possible results of a surgical cure (and they 
certainly are), the patient has obtained results at less cost of 
personal suffering and without placing her life in the balance 
even for a moment of time. In the one case the surgeon 
makes quick work of the operative part of the treatment 
while ihc patient bears the brunt of the battle, and nurses and 
assistants do a great deal of work to complete what the knife 
began. 

In the other case the brunt of the operative procedure is 
borne by the physician. The nurse, the rigorous preparation, 
the antiseptic dressings and the anxiety are left out of the 
count altogether and the patient herself is put to the least 
trouble. Even if a case attended with severe symptoms is 
advised to rest in bed for several hours daily, she is subject 
to few of the restrictions attending recovery from a major 
operation. ; . 

Clinical Results. — Apart from the immense aid of static 
electricity in the constitutional treatment of all the conditions 
of ill-health associated with pelvic diseases and the important 
therapeutic actions of induction coil currents in their local 
reinforcement of intra-uterine galvanic applications the power- 
ful tonic and physiological polar actions (positive and negative), 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 513 

of the latter produce beneficial effects upon the patient with a 
fibroid tumor which depend upon : 

1. The size, character and rapidity of growth of the tumor. 

2. Its situation within, or without, the direct path of the 
current. 

3. The symptoms caused by the tumor ; severity and 
chronicity. 

4. The complications co-existing. 

5. The general health of the patient. 

6. The thoroughness of treatment. 

Patients who are very little disturbed by symptoms, or whose 
general health is not yet much impaired, will discover very 
little benefit which they can appreciate at the time. The value 
of local electrical treatment in these cases must relate chiefly 
to prophylaxis. If the effect of a few months' galvanic treat- 
ment is simply the arrest of the growth and a slight retro- 
cession of bulk, the value of the treatment will probably 
appear later on. 

Small Fibroids of All Kinds.— Small benign tumors of the 
uterus are pretty sure to be benefited by intra-uterine gal- 
vanic applications irrespective of the situation of the growth. 
There is a prospect of complete cure when the growth is 
interstitial and an almost equally good prospect of radical cure 
in cases which are not quite entirely interstitial. 

If all incipient cases were discovered .and treated in their 
early development by the combined resources "of medical and 
electrical methods only a small minority of patients would 
reach a stage of chronic suffering and menace to life. 

Sub-peritoneal Fibroids. — If the health of the patient is 
impaired to any marked degree the general tonic, nutritional 
and other physiological actions of the different forms of elec- 
tric currents will aid in the treatment of the patient, but 
unless something be done in accordance with some clearly 
defined indication for local galvanic treatment, it is not 
worth while to attempt to attack these tumors with elec- 
trolysis. Build up the general health, employ the resources 
33 



514 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

of drugs, and electricity for its general effects, and await the 
time (which may or may not come) when surgical interference 
will be necessary. As these cases constitute about 20 per 
cent, of all fibroids and while refusing an operation may 
desire to determine the possible benefit of electricity passed 
directly through the tumor, there is no reason why an effort 
should not be made, even though out of ten such cases no 
more than four or five obtain the best results. It is the situa- 
tion, and not always the character of these tumors which 
makes them difficult to treat by non-surgical methods. 

Sub-mucous Fibroids. — When these are easily enucleated 
there is no place for local electrolysis in their treatment. If 
they produce symptoms which threaten the. health they are a 
case for the surgeon, but both to improve the general health 
before the operation and most quickly restore the mental and 
physical condition of the patient after the operation, we have 
invaluable remedies in bipolar faradization and static elec- 
■ tricity. The percutaneous or intra-uterine application of the 
galvanic current may be helpful to reduce a hemorrhagic ten- 
dency, but the general symptoms will be greatly relieved by 
the other currents. 

Fibroids of Rapid Development, Fibroids of Cystic Nature, 
Suppurating Fibroids, Multiple Intramural Fibroids. — The 
resources of both static and galvanic currents, together with 
vaginal bipolar faradization (whenever it is indicated), will assist 
medication and nutrition in repairing the general health before 
an Operation and will render immense assistance durmg the 
period of convalescence. 

Inoperable and Complicated Fibroids. — In considering the 
clinical results which may sometimes be procured in cases that 
the surgeon declines, Martin states' as follows: 

The cases which are referred to the writer are for the most part 
complicated cases which the ordinary surgeon shuns. One com- 
plication which frequently induces the surgeon to shift the re- 
sponsibility of these cases is that of severe purulent metritis 
and endometritis, accompanied frequently with discharges of 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 515 

gangrenous masses from sub-mucous fibroids, all accompanied 
with much pain, more or less hemorrhage, and with the dis- 
charges inclined to be very offensive. The patients are usually 
poorly nourished, with white and waxy skin, in consequence of 
septic absorptions. 

When they reach this stage they are frequently pronounced 
malignant. The outlook for an operation is certainly not flat- 
tering. Usually in these cases we have to deal with a tumor 
of large size, extending to the umbillicus. It is soft, with 
nodular masses projecting from its peritoneal surfaces. The 
cervix is soft and patulous, with a canal large and irregular. 
Sometimes a small nodular jnass is presented at the cervix. 
This is usually soft and easily broken down. The endo- 
metrium and all cavities from .which masses have been pro- 
jected or from which they have sloughed away are infected 
and ulcerated, emitting a discharge which rapidly becomes 
offensive. From the large mucous membrane occur periodic 
and irregular uterine discharges which serve to swell the 
already copious outpour. 

The writer has treated by electricity and symptomatically 
cured several of these cases in which the diagnosis of cancer 
had been made by conscientious surgeons of more than ordi- 
nary talent. 

These cases respond rapidly. The powerful antiseptic action 
(of metallic electrolysis) on the mucous membrane makes itself 
apparent by the decreased odor of the discharge. The pass- 
ing and withdrawing of the electrode opens and provides free 
drainage for the secretions. The discharge of blood is lessened. 
The patient is toned mentally and physically by the general 
effect of electricity on her system. In a word, Lt is frequently 
marvellous what a transformation will take place in these ap- 
parently hopeless cases in a few weeks of judicious galvanic 
treatment. 

While these cases are apparently hopeless from the stand- 
point of the surgeon, they are frequently symptomatically 
cured by this simple remedy. The writer has a long list of 
such cases, and they constitute some of the most satisfactory 
work he has ever had placed to his credit. 

There is a class of complicated cases of different kinds in 
which it is impossible, because of the contortions of the growth, 
to enter the uterine canal with an electrode. Only in the most 
desperate cases, in which submitting to an operation is clearly 
suicidal, would one think of employing electricity as a means 
of treatment when an intra-uterine electrode was impossible. 
But it is in just these cases, with their distressing neuralgic 
and pressure symptoms, with dyspeptic complainings and in- 



5l6 UTERINE FIBROIDS AND TREATMENT OF PATIENTS. 

testinal irritations, the result of reflex nerve disturbances, in 
which an operation is discouraged, that we find patients ready 
to catch at any straw. 

In many of these cases I believe that electricity not only offers 
a straw but a veritable life-boat to their despairing bodies. 

All that we can expect to accomplish is that beneficial action 
derived from passing a strong galvanic current through any 
tissue containing muscles, nerves, lymphatics and blood-ves- 
sels, viz., a powerful trophic stimulation to the part and inci- 
dentally a powerful general tonic effect on the general system. 

These cases get great relief. Neuralgias stop. Trouble- 
some abdominal reflexes cease. Circulation is improved. Nu- 
trition is stimulated. Sleeplessness disappears. Bowels are 
stimulated and relieved of troublesome distension symptoms. 
The tumors often seem to decrease in size. 

The degree to which each of these symptoms is relieved 
varies of course in individual cases. • The writer has seen a 
large number of cases completely, and for an indefinite time, 
relieved of all these symptoms. In fact, some of the most 
gratifying cases of relief he has had are of this variety. These 
cases are apparently so hopeless that often any relief is very 
gratifying. 

Typical Bleeding Fibroids of Interstitial Variety. — This 
is the class of cases making up a very large percentage of all 
fibroids in which electricity finds its best field of employment 
and may be considered adequate to relieve the patient from 
the dread of an operation, except in rare cases. Sometimes a 
complete anatomical reduction of the tumor is effected as com- 
pletely as if it had been cut out, but only an arrest of develop- 
ment with a partial shrinkage in size is expected to result from 
ordinary treatment. 

When patients are relieved of their complaints, they seldom 
continue treatment for theoretical advantages, and if the tumor 
no longer gives them any trouble they are usually happy. 

Static electricity, for its general constitutional effects, and 
vaginal bipolar faradization, are practically an indispensable 
auxiliary part of the treatment of fibroids by galvanic cur- 
rents. No single remedy or single type of current suffices. 

In these cases the clinical results are either a great ameliora- 
tion of all the symptoms with perhaps some lingering com- 



UTERINE FIBROIDS AND TREATMENT OF PATIENTS. Si/ 

plaint in one or two of the most obstinate disturbances, or a 
complete " symptomatic cure," which may at some future 
time break down under impaired general health and require a 
fresh period of treatment to establish it again. 

These cases begin to improve almost immediately. The 
first improvement is the relief of the two cardinal symptoms, 
hemorrhage and pain. Grand and Famarque state that hav- 
ing followed attentively all the patients in Apostoli's clinic 
for more than four years they have seen no case of the above 
character in which hemorrhage was not arrested, and only in 
rebellious hemorrhages of malignant neoplasms have they seen 
the combined resources of electricity fail. All the functional 
disorders, dysmenorrhcea, amenorrhoea, leucorrhoea, vesical 
irritability, constipation, neuralgic pains, muscular achings, 
cardiac and other neuroses, etc., disappear entirely or greatly 
- improve. 

For the control of pain electricity is much more certain than 
surgery, and two of the greatest triumphs of electrical treat- 
ment as now employed are the control of hemorrhage and the 
relief of pain. The efficient treatment of the endometritis 
which almost invarig,bly is found in fibroid cases is a third 
triumph of galvanic currents. 

Of the results obtained in these typical cases by electrical 
treatment in his own experience during the past ten or more 
years Martin states: 

The first improvement, following almost the first siance, is 
the relief of neuralgic and so-called pressure pain. In a few 
days they find that their general strength is improved. Reflex 
disturbances, such as stomach irritation, palpitation of the 
heart, occipital headache and backache will be relieved. The 
patient will begin to eat and sleep naturally. There is a 
general feeling of well-being engendered. 

In a few days the leucorrhoea or purulent discharge from 
the endometrium will diminish. As the patient arrives near 
the menstrual period she finds that the old pre-menstrual 
aches are not present and the old despondency is absent. If 
the treatment has been sufficiently active the menstrual flow 
will arrive without pain in many cases. Occasionally, the 
first month the flowing is fully as free as usual, although 



Sl8 UTKRINE FIBROIDS AND TREATMENT OF PATIENTS. - 

frequently it is much reduced. If the treatment is continued 
for two or three months these patients will begin to maintain 
that they feel perfectly well. 

All the old distressing symptoms will very often disappear 
entirely. They will gain flesh and the uterine discharge will 
become normal. 

While the tumor will still be apparent to the physician's 
examination it will almost invariably be found much diminished 
in size. When the time arrives that these patients are 
symptomatically cured, that is when they feel no symptoms, 
I usually discharge them. As long as they are free from 
symptoms they may be satisfied that the tumor is not grow- 
ing — on the contrary is decreasing in size. 

Fibroids with Peri-uterine Inflammatory Complica- 
tions. — If these complications are not suppurating, or of a 
character which either threaten life or prevent successful 
electrical applications, but are simple acute, subacute or 
chronic inflammations of any of the pelvic tissues, the final 
results of preparatory bipolar faradic sedation and later treat- 
ment by modified galvanic currents will probably be satis- 
factory to the patient and obviate any need for an operation, 
but the progress of the case will necessarily be very much 
slower than cases which are not thus complicated. 

During the past ten years so many reports of clinical cases 
with large percentages of good results have been published 
that it is no longer necessary to present evidence of the fact 
that electricity is the chief of conservative therapeutic 
measures and that the clinical results in carefully selected 
cases are as good, from the operator's standpoint, as the best 
results of hysterectomy, while from the patient's standpoint 
they are much better, for she still possesses her tubes, ovaries and 
uterus, and anticipates none of the uncertainties of an arti- 
ficial menopause produced perhaps five, ten or more years 
before the time set by nature. 

Electricity, when it relieves, does not mutilate, leaves no 
stump or adhesions to be the site of obscure pains, and while 
it is performing its gradual work upon the fibroid it is also 
establishing general benefit to the patient's health, comfort 
and mental condition, which is of inestimable value. 



CHAPTER XXX. 

ELECTRICAL TREATMENT OF DIFFERENT VARIETIES 

OF FIBROIDS. 

Treatment of fibroids without serious symptoms or complications. Treatment of 
fibroids with various degrees of liemorrhage. Treatment of fibroid patient 
with suspected complication which may contra-indicate electricity. Treat- 
ment of intra-mural fibroid, single or multiple, situated in close proximity to 
the mucous membrane. Intra-uterine pedunculated fibroids. Sub-mucous 
fibroids of considerable size. Small uncomplicated fibroids of all varieties 
except pedunculated polypi. Interstitial fibroid of moderate size with desper- 
ate and profuse hemorrhage. Fibroid comj)Iicated with pyosalpinx, ovarian 
cyst, or ovarian abscess. Cystic fibroids. Suppurating fibroids. Large 
fibroids complicated with pregnancy. Sub-peritoneal fibroids. 

Any synopsis of a large subject offers less direct help to the 
formation of judgment to meet the needs of an individual case 
than does the consideration of separate cases in detail. I 
shall now outline suggestions for treatment in the manner 
which I believe to be most instructive to the practitioner who 
is not a specialist. The directions given will not be influenced 
by a one-sided advocacy of electricity but will be such as 
commend themselves to the author's judgment as best for the 
welfare of the patient. 

Treatment of a Fibroid Patient without Serious Symptoms 
or Complications Before a Complete Diagnois is Determined. 
— Investigate first the general health of the patient in every 
case, and prescribe diet, hygiene and medication directed to 
putting her in the best possible state of nutritional tonicity. 

While the first pelvic examination may satisfy the physician 
that he has to deal with a fibroid tumor of a more or less defi- 
nitely ascertained character, yet there are a number of things 

519 



520 ELECTRICAL TREATMENT OF FIBROIDS. 

that touch alone does not discover even when aided by the 
eye and ear. A complete understanding of each case may be 
considered a somewhat gradual development, and therefore the 
treatment of the fibroid does not really begin at the first 
sitting. 

After the bi-manual examination and other methods which 
may be employed the first preparatory step is bipolar faradiza- 
tion. 

To avoid repeating in detail the full technique of all varia- 
tions of this method the reader is referred to the section 
describing it in full. (See INDEX.) 

Leave the patient in the dorsal position upon the operating 
table exactly as she was placed for the bi-manual examination, 
and at once, after ending the examination, connect the tip of 




Fig. 205. Bipolar vaginal electrode. 

the vaginal bipolar electrode with the positive; pole of the 
high-tension induction coil apparatus and the remaining half 
to the negative pole. Warm and lubricate the electrode with 
a little plain vaseline and insert it as deeply as it will go into 
the cul-de-sac of the vagina. 

Retain it carefully in position during the stance so that it 
cannot possibly slip out. Switch the 1,500 yard No. 36 coil, 
four cells and the rapid vibrator into circuit and regulate the 
current strength from zero up to the point of strongly marked 
sensation. 

If this requires a. dosage of mild sedative action, and pain is 
felt when the current is somewhat increased, repeat the seda- 
tive applications daily and observe the effect. If congestion, 
tenderness and pain are of a simple nature they will rapidly 
disappear under the efficient influence of bipolar faradic seda- 
tion, which will not only compose the nervous system, fortify 



ELECTRICAL TREATMENT OF FIBROIDS. $21 

the patient against timid fears of being hurt, win her confi- 
dence and gratitude for the great benefit this preparatory treat- 
ment produces, but will add another point to the diagnosis. 
It at once determines between pain due to an inflammation of 
the appendages and all other pains of a functional, congestive, 
nervous or hysterical nature. 

If the tissues are not sensitive and at the first sitting the 
current from the 1,500 yard coil with the full E.M.F. of four 
or five cells is scarcely felt and a toleration is demonstrated to 
strong cu-rrents from any of the shorter coils of No.- 36, No. 32, 
or coarser coils, it is almost certain that inflammatory com- 
plications do not exist, and this is an important fact to de- 
termine before commencing intra-uterine galvanic treatment. 

At the second or third sitting (if the patient is not irritable 
or timid so as to require further bipolar sedation) place her 
in exactly the same position and make a test application of an 
intra-uterine positive galvanic current. 

Thoroughly moisten in the soda bicarbonate hot-water solu- 
tion a felt-covered, flat electrode, 7X 10, and place it upon the 




Fig. 206. Fine felt or sponge covered electrode — assorted sizes with soft rubber 

insulating backs. 

lower abdomen or beneath the sacrum, whichever is most con- 
venient. Connect this electrode with the negative pole of the 
galvanic battery. Place it in position y?rj/ so that it will be 
saturating the tissues and reducing the resistance of the skin. 
Next irrigate the vagina thoroughly with the antiseptic solu- 



522 ELECTRICAL TREATMENT OF FIBROIDS. 



Fig. 207. Intra-uterine electrode, platinum stem, two and a half inches long. 
Size, No. II, French. 

tion which the operator is accustomed to employ. Sterilize 
next the platinum intra-uterine electrode-sound in the usual 
alcohol flame and connect it with the positive pole of the 
galvanic battery and insert it to the fundus of the uterus. In 
all simple cases when a speculum will easily engage the cervix 
I prefer to use it during the galvanic application, but in all 
other cases it is best omitted, and it is not a necessity. When 
the operator's hand guides the electrode it should be surgically 
clean. 

Support the electrode in natural position without pressure 
and increase the constant galvanic current through the rhe- 
ostat very gradually up to about thirty mil. In many cases 
fibroids are less sensitive than the uterine tissues usually, but 
the object of this application is not yet to treat the fibroid but 
to test the tolerance as one of the final important steps in the 
diagnosis. 

Request the patient to speak when the current hurts her 
and again cautiously increase the dose still further until she is 
comfortably conscious of the intra-uterine current. If this 
dosage (now held stationary).becomes even more comfortable 
and less perceptible each moment, if the meter registers be- 
tween 40 and 60 mil., and if after about five minutes the 
current is reduced to zero and the patient then expresses a 
.sense of well-being, the fibroid is probably without complica- 
tions. 

After withdrawing the electrodes repeat the antiseptic 
vaginal irrigation and insert a loose tampon of antiseptic gauze 
around the cervix, to be removed by the patient the next 
morning. Have her return the next day to report. 

In the intra-uterine treatment of any condition which em- 



ELECTRICAL TREATMENT OF FIBROIDS. $23 

ploys above 50 mil. of the positive galvanic current contrac- 
tions of the uterus will be set up. These will cause moderate 
contraction pains after the application which the patient will 
define as colic. So long as colic only is complained of, and 
especially if this passes away upon resting in a recumbent 
position for a short time after treatment, the indications are 
good. But if other post-operative pains, distress or a febrile 
reaction occurs there is reason to suspect some peri-uterine 
inflammatory state which will require either a reduction of the 
dose temporarily, or another form of application must be sub- 
stituted until this lesion abates. 

If there is chilliness or chills, faintnessand other symptoms, 
developing an hour or so after treatment, the presence of pus 
in the tubes may be suspected. If a salpingitis exists which 
is not yet quite advanced to suppuration it will cause similar 
but less severe symptoms. If the fibroid is complicated with 
some uterine or peri-uterine inflammation, the degree of the 
inflammation, and v/hether it is suppurating, or of a simple 
chronic character, is revealed by the intensity of the febrile 
symptoms which follozu the galvanic application of sufficient 
strength to aggravate. 

If, however, the patient returns and says that she either " felt 
nothing" or only a little " colic " or " pain in the back," which 
quickly passed away, and that she not only feels no worse but 
thinks she felt brighter and possibly slept a little better, it can 
be affirmed that the fibroid is without complications and a 
systematic plan of treatment can now be carried out. The 
best future treatment which can' be given this patient will 
embody the following : 

1. Measures to sustain and promote nutrition. 

2. Static administrations to reinforce the above, aid sleep, 
combat neurasthenia, strengthen the nerve forces and relieve 
reflex, nervous and other symptoms not those of mechani